This is an old, rarely described finding in patients with aortic stenosis. The initial description in 1910 could have actually been a series of patients with undiagnosed hypertrophic cardiomyopathy rather than aortic stenosis.
Right ventricular failure with systemic venous congestion, hepatomegaly and edema may precede left ventricular failure in patients with left ventricular hypertrophy. Patients may have elevated right atrial and right ventricular end-diastolic pressures.
Inspection of the jugular veins may reveal increased pressures with prominent 'a' waves. This is called the Bernheim effect.
It is presumably due to the hypertrophied ventricular septum encroaching on the right ventricular cavity - leading to obstruction of right ventricular filling.
Huang MT, Goodman MA, Delaney TB. Pre-infarction angina secondary to calcific aortic stenosis with Bernheim's effect. Clin Cardiol. 1978 Aug;1(2):107-11
Bernheim P.I.: De l'asystolie veineuse dans l'hypertrophie du coeur gauche par stenose concomitante du ventricule droit. Rev.Med.,30,785-801,1910
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