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An easily heard [[Systole (medicine)|systolic]], crescendo-decrescendo (i.e., 'ejection') [[heart murmur|murmur]] is heard loudest at the upper right sternal border, at the [[Heart auscultation#Surface anatomy|2nd right intercostal space]],<ref name=uas/> and radiates to the [[carotid artery|carotid arteries]] bilaterally.<ref name="Asymptomatic"/><ref name=agabegi2nd-ch1/> The murmur increases with squatting and decreases with standing and isometric muscular contraction such as the [[Valsalva maneuver]], which helps distinguish it from [[hypertrophic obstructive cardiomyopathy]] (HOCM). The murmur is louder during expiration but is also easily heard during inspiration. The more severe the degree of the stenosis, the later the peak occurs in the crescendo-decrescendo of the murmur.<ref>Alpert MA. Systolic Murmurs. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 26. Available from: https://www.ncbi.nlm.nih.gov/books/NBK345/</ref>
The second heart sound ([[Heart auscultation#S2|A<sub>2</sub>]]) tends to become decreased and softer as the aortic stenosis becomes more severe.<ref name=uas/> This is a result of the increasing calcification of the valve preventing it from "snapping" shut and producing a sharp, loud sound. Due to increases in [[left ventricular pressure]] from the stenotic aortic valve, over time the ventricle may hypertrophy, resulting in diastolic dysfunction. As a result, there may be a [[fourth heart sound]] due to the stiff ventricle.<ref name=agabegi2nd-ch1/> With continued increases in ventricular pressure, dilatation of the ventricle will occur, and a third heart sound may be manifest.
Finally, aortic stenosis often co-exists with some degree of [[aortic insufficiency]] ([[aortic regurgitation]]). Hence, the physical exam in aortic stenosis may also reveal signs of the latter, for example, an early diastolic decrescendo murmur. Indeed, when both valve abnormalities are present, the expected findings of either may be modified or may not even be present. Rather, new signs that reflect the presence of simultaneous aortic stenosis and insufficiency, e.g., [[pulsus bisferiens]], emerge.{{cn|date=February 2021}}
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