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Clinical Clue of Severe Aortic Stenosis: Simultaneous Palpation of the Carotid and Apical Impulses

Clinical Clue of Severe Aortic Stenosis: Simultaneous Palpation of the Carotid and Apical Impulses Abstract • In patients with severe aortic stenosis, simultaneous palpation of the carotid and apical impulses yields a palpable lag time between the two. Apexcardiograms and carotid pulse tracings were recorded in 66 control subjects and in 30 patients with aortic stenosis. Using the QRS peak as reference, the peak appearance time of the carotid pulse tracings and apexcardiograms was measured, and the difference was calculated as a palpable lag time; 21/30 patients had a palpable lag time, whereas nine did not; 22/30 patients with aortic stenosis had aortic valve areas of less than 1 sq cm. Twenty-one of these 22 patients had a palpable lag time. The sensitivity of a palpable lag time for aortic valve areas of less than 1 sq cm was 95%, specificity 100%, positive predictive value 100%, and negative predictive value 89%. The group means for measured lag times between controls (70 ± 7 ms) and those patients with aortic stenosis (133 ± 7 ms) showed a definite difference. The palpable lag time by linear regression analysis had an r of .68, third in rank to the aortic valve gradient and ECG for predicting aortic valve area. Multiple regression analysis found the palpable lag time, ECG, syncope, and shudder waves together able to predict the aortic valve area (r = .85). Back to top Article Information Accepted for publication July 11, 1982. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. Reprint requests to Cardiology Service, Box 1399, Tripler Army Medical Center, Tripler AMC, HI 96859 (Dr Chun). References 1. Eddleman EE, Frommeyer WB, Lyle DP, et al. Critical analysis of clinical factors in estimating severity of aortic valve disease. Am J Cardiol. 1973;31:687-695. PubMedGoogle ScholarCrossref 2. Cousins AL, Eddleman EE, Reeves TJ. Prediction of aortic valvular area and gradient by noninvasive technique. Am Heart J. 1978;95:3080-315. PubMedGoogle ScholarCrossref 3. Voelkel AG, Kendrick M, Pietro DA, et al. Noninvasive tests to evaluate the severity of aortic stenosis. Chest. 1980;77:155-60. PubMedGoogle ScholarCrossref 4. Bonner AJ, Sacks HN, Tavel ME. Assessing the severity of aortic stenosis by phonocardiography and external carotid pulse recordings. Circulation. 1973;48:247-252. PubMedGoogle ScholarCrossref 5. Hawker RE, Seara CA, Krovetz LJ. Distal modification of the arterial pulse wave in children with congenital aortic stenosis. Circulation. 1974;50:181-187. PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Clinical Clue of Severe Aortic Stenosis: Simultaneous Palpation of the Carotid and Apical Impulses

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.142.13.2284
Publisher site
See Article on Publisher Site

Abstract

Abstract • In patients with severe aortic stenosis, simultaneous palpation of the carotid and apical impulses yields a palpable lag time between the two. Apexcardiograms and carotid pulse tracings were recorded in 66 control subjects and in 30 patients with aortic stenosis. Using the QRS peak as reference, the peak appearance time of the carotid pulse tracings and apexcardiograms was measured, and the difference was calculated as a palpable lag time; 21/30 patients had a palpable lag time, whereas nine did not; 22/30 patients with aortic stenosis had aortic valve areas of less than 1 sq cm. Twenty-one of these 22 patients had a palpable lag time. The sensitivity of a palpable lag time for aortic valve areas of less than 1 sq cm was 95%, specificity 100%, positive predictive value 100%, and negative predictive value 89%. The group means for measured lag times between controls (70 ± 7 ms) and those patients with aortic stenosis (133 ± 7 ms) showed a definite difference. The palpable lag time by linear regression analysis had an r of .68, third in rank to the aortic valve gradient and ECG for predicting aortic valve area. Multiple regression analysis found the palpable lag time, ECG, syncope, and shudder waves together able to predict the aortic valve area (r = .85). Back to top Article Information Accepted for publication July 11, 1982. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. Reprint requests to Cardiology Service, Box 1399, Tripler Army Medical Center, Tripler AMC, HI 96859 (Dr Chun). References 1. Eddleman EE, Frommeyer WB, Lyle DP, et al. Critical analysis of clinical factors in estimating severity of aortic valve disease. Am J Cardiol. 1973;31:687-695. PubMedGoogle ScholarCrossref 2. Cousins AL, Eddleman EE, Reeves TJ. Prediction of aortic valvular area and gradient by noninvasive technique. Am Heart J. 1978;95:3080-315. PubMedGoogle ScholarCrossref 3. Voelkel AG, Kendrick M, Pietro DA, et al. Noninvasive tests to evaluate the severity of aortic stenosis. Chest. 1980;77:155-60. PubMedGoogle ScholarCrossref 4. Bonner AJ, Sacks HN, Tavel ME. Assessing the severity of aortic stenosis by phonocardiography and external carotid pulse recordings. Circulation. 1973;48:247-252. PubMedGoogle ScholarCrossref 5. Hawker RE, Seara CA, Krovetz LJ. Distal modification of the arterial pulse wave in children with congenital aortic stenosis. Circulation. 1974;50:181-187. PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Dec 1, 1982

Keywords: aortic valve stenosis,palpation,apical impulse,syncope,linear regression,aortic valve area,aortic valve

References