Aortic stenosis is a heart condition where the aortic valve has narrowed. To properly diagnose it, listening to heart sounds while the patient performs an isometric handgrip can help distinguish an aortic stenosis murmur from a mitral murmur, as the aortic murmur will decrease in intensity but a mitral murmur will increase. The aortic stenosis murmur also increases after a premature ventricular contraction due to the enhanced diastolic filling and compensatory pause raising the gradient across the valve.

1. AORTIC STENOSIS

8. •It is important to appreciate this so you do not
mistakenly diagnose a nonexistent mitral murmur. If the
patient performs an isometric handgrip while you listen
at the apex, you will hear the aortic stenosis murmur
with Gallavardin phenomenon decrease in intensity. A
coexistent mitral insufficiency murmur will increase in
intensity with this maneuver.
The aortic stenosis murmur increases after a premature
ventricular contraction due to the increased gradient
across the valve produced by the enhanced diastolic
filling with the compensatory pause.

9. STROKE VOLUME INDEX
SV/BODY SURFACE AREA