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the triad that you're looking for chest
pain sure
with that bigger thickness of the left
ventricle wall you're going to have
angina
because maybe perhaps you can't supply
enough employed heart failure late
finding remember early on the left
ventricle is lifting weights and so
therefore could you is it possible that
your ejection fraction could be
preserved early on and Eric stenosis
sure it can so your ejection fraction
would be what exactly your stroke volume
over edv isn't it so therefore when you
have air dexter notices early on your
ejection fraction could actually be
preserved please be careful do not
confuse that with congestive heart
failure as we shall see later on now as
you continue and there isn't proper
management of your patient Eric stenosis
guess what happens that ejection
fraction is going to get compromised and
you will go into major heart failure and
if you do at that point at the bad
prognostic indicator here we go there's
the s-1 and s2 what did we say about
this a crescendo decrescendo right
because they are take vows was intent to
open immediately tell me about the left
ventricular pressure increased or
decreased in comparison to Eric pressure
increased love ventricular pressure
remember the area underneath that curve
the discrepancy between those two curves
represents Eric stenosis
what do you hear this right upper area
right so you find that a ripe right
upper second Cup in a cost of space
that's where you find Eric stenosis to
be the loudest it would be radiating
where to the carotid and lastly in terms
of s2 well which second heart sound will
then close first pulmonic followed by a
auric which is called paradoxical
splitting remember that
so with s2 I told you that there are
particular heart sounds that you want to
pay attention to physiologic verses
widened versus fixed in this case where
paradoxical
the physical examination you would
expect the left ventricle to work really
hard because of increased pressure and
so therefore it will be hyper dynamic
and it's enlarged but left ventricular
hypertrophy you want to make sure that
you catch your patient early on with
aortic stenosis because if that ejection
fraction starts dropping what I say
about prognosis dismal you don't want
that to happen so I need you to be
astute please next an important point is
this something called pulses parvis and
taurus what this means is slow and late
carotid pulse due to wide pay attention
here left ventricle wants to eject blood
during one during systole your patient
has bicuspid aortic valve Wow what can
calcification dystrophic resulting in
aerodeck stenosis what happen a cardiac
output decreased so when you have
decreased cardiac output then what
happens to the post and such it's a
delayed so slow and late is what it's
called pulses Parviz and tardis slow and
late carotid pulse due to what delay in
blood flow across that stenotic artic
valve it is that simple for you to
understand are you gonna have
differential pressures here no such
thing differential pressure give me give
me diagnose wouldn't mean differential
pressure dr. rush increased pressure and
upper extremity lower pressure in the
lower extremity
that's a differential pressure that
what's your diagnosis that your
coronation of the order to be careful
you want to try to bring in
differentials here
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