Q. How to investigate aortic stenosis by Electrocardiogram?

Typically left ventricular hypertrophy with strain pattern is seen in severe aortic stenosis. Total QRS amplitude in mm. tends to correlate and equals trans aortic gradient in pure aortic stenosis. A normal ECG though suggestive of mild aortic stenosis does not totally eliminate severe aortic stenosis. Left atrial enlargement, left axis deviation and various kinds of conduction abnormalities including left bundle branch block, 1° heart block or even complete heart block may occur. Though atrial fibrillation may occur in an advanced aortic stenosis with decompensation-one should eliminate concomitant mitral valve disease.