**3.10 Clinical features**

### *3.10.1 Clinical presentation*

### *3.10.1.1 Symptoms*

Patients with, mild or moderate AS are usually asymptomatic unless they have the coexisting cardiopulmonary disease or infective endocarditis. Patients often remain asymptomatic until the ventricle begins to fail. At this initially, they usually develop fatigue followed by cardinal symptoms of angina, syncope, and dyspnea expected survival following the onset of these symptoms is 2, 3, and 5 years, respectively [38].

In rare instances, sudden tragic death is the first manifestation of the disease. Patients may be sedentary; it unclear whether they are inactive by choice or have gradually restricted their activity to avoid symptoms. A treadmill stress test under close medical supervision may help in their assessment.

### *3.10.1.2 Physical findings*

The classic finding in the assessment of peripheral pulses is a delayed and slowly rising wave contour pulsus parvus et tardus. However, it may be absent patients with associated aortic regurgitation or in patients with associated aortic regurgitation or calcified, inelastic arteries.

Precordial palpation may reveal a sustained and laterally displaced cardiac impulse. Because the hypertrophied LV is noncompliant, the critical contribution to filling provided by atrial contraction severe thrill is often palpable at the base of the heart.
