Bicuspid aortic stenosis physical examination

Cardiac Examination

 * There is a systolic murmur from birth (occurs later in life in acquired AS). It is heard best in aortic area (2nd intercostal space along right sternal border)
 * Paradoxical splitting of 2nd heart sound occurs in severe aortic stenosis
 * Unlike acquired aortic stenosis(AS), the contour of the carotid pulse is not a good predictor of severity in congenital AS because it is so variable.
 * Because the valve is not calcified early on in the case of a fused valve, an ejection click may be present unlike acquired AS.
 * Patients often have an S4.
 * In presence of aortic insufficieny, a diastolic murmur may be heard. Various maneuvers such as isometric handgrip, having patients lean forward in a seated position helps in hearing the murmur better.

Other Physical Features Related to Associated Syndromes

 * Turner's syndrome
 * Short stature female
 * Webbed neck
 * Low hairline
 * Broad chest with wide spaced nipples
 * William's syndrome
 * Elfin facies
 * Mild retardation
 * Autism