Brachio-Radial Delay

We saw an elderly gentleman and examined the cardiovascular system.
On examination of his head the only physical sign we noticed was that his palate was very high-arched.
There was no abnormality noted on examination of his hands.
His pulse rate was 70 beats per minute, regular in rhythm, low volume, slow rising.
This immediately made us think of aortic stenosis.
There was an appreciable delay between the brachial pulse and the radial pulse; brachio-radial delay. This physical sign too was in favour of aortic stenosis.
There was no abnormality noted on examination of his neck.
The praecordium looked normal. The apex beat was at the 5th intercostal space in the mid clavicular line and was of normal character.
The first heart sound was of normal intensity on auscultation but the second heart sound was soft. Another sign in favour of aortic stenosis.
There was an ejection systolic murmur, which radiated into his neck. This helped us confirm our suspicion that the patient had aortic stenosis.
The important learning points here are to recognise and correctly interpret the signs picked up early on in the examination of the cardiovascular system. The diagnosis was made on examination of the radial and brachial pulses and auscultation of the heart was used to confirm the diagnosis.