Valvular | Supravalvular | Discrete subvalvular | Obstructive hypertrophic cardiomyopathy | |
Pulse pressure after ventricular premature beat | Increased | Increased | Increased | Decreased |
Valsalva effect on systolic murmur | Decreased | Decreased | Decreased | Increased |
Murmur of aortic regurgitation | Common after age 40 | Rare | Sometimes | No |
Fourth heart sound (S4) | If severe | Uncommon | Uncommon | Common |
Paradoxic splitting | Sometimes* | No | No | Common* |
Ejection click | Most (unless valve calcified) | No | No | Uncommon or none |
Maximal thrill and murmur | Second RIS | First RIS Suprasternal notch | Second RIS | Fourth LIS |
Carotid pulse | Normal to anacrotic* (parvus et tardus) | Unequal | Normal to anacrotic | Brisk, jerky, systolic rebound |
Valve calcification | Common after age 40 | No | No | No |
Dilated ascending aorta | Common after age 40 | Rare | Rare | Rare |
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