Symptoms
Classic triad of symptoms:
- Angina
- Can occur with normal coronary arteries
- Caused by increased myocardial oxygen demand due to LV hypertrophyvCompounded by reduced myocardial oxygen supply due to LV hypertrophy distorting flow and coronary calcification
- Syncope
- Occurs during exercise
- Likely due to fixed cardiac output state failing to meet increased demands leading to a drop in cerebral perfusion
- Dyspnoea
- High diastolic pressure leads to pulmonary congestion
- Usually occurs late in disease
Signs
Heart Sounds
- Ejection systolic murmur:
- Harsh, crescendo-decrescendo in nature
- Loudest over the aortic area (second right intercostal space)
- Exacerbated by asking the patient to lean forward and taking a deep breath in.
- May radiate to the carotids.
- May lessen in intensity as the severity increases due to reduced cardiac output
- Ejection click preceding murmur
- Soft or absent S2
Other
- Slow rising pulse
- Low blood pressure and narrow pulse pressure
- Heaving apex beat
- Thrill:
- Precordial
- Carotid
- Inspiratory crepitations (if pulmonary oedema)