Differential Diagnosis for Murmur of Aortic Stenosis with Gallavardin versus Mitral Regurgitation

When differentiating the murmur of Aortic Stenosis with Gallavardin from Mitral Regurgitation, consider the following categories:

• Single Most Likely Diagnosis:

  • Aortic Stenosis: This is the most likely diagnosis when considering the Gallavardin phenomenon, which is a harsh, diamond-shaped systolic murmur best heard at the right second intercostal space, characteristic of severe aortic stenosis. The murmur can sometimes be mistaken for Mitral Regurgitation due to its radiation to the apex.

• Other Likely Diagnoses:

  • Mitral Regurgitation: This condition presents with a pansystolic murmur best heard at the apex, which can sometimes be confused with the murmur of aortic stenosis when the latter radiates to the apex, as seen in the Gallavardin phenomenon.
  • Hypertrophic Obstructive Cardiomyopathy (HOCM): This condition can also present with a systolic murmur that may be confused with aortic stenosis, especially if the murmur is dynamic and changes with maneuvers.

• Do Not Miss Diagnoses:

  • Aortic Dissection: Although less likely, aortic dissection can present with a new-onset aortic regurgitation murmur or can complicate severe aortic stenosis. It is critical to consider this diagnosis due to its high mortality rate if missed.
  • Endocarditis: Infective endocarditis can complicate both aortic stenosis and mitral regurgitation, leading to acute valvular dysfunction. It is essential to consider this diagnosis due to its potential for severe morbidity and mortality.

• Rare Diagnoses:

  • Subvalvular Aortic Stenosis: A congenital condition that can cause a systolic murmur similar to valvular aortic stenosis but is less common.
  • Supravalvular Aortic Stenosis: Another congenital condition that can cause a systolic murmur, typically best heard over the aortic area and along the carotid arteries.
  • Pulmonary Stenosis: Although typically presenting with a different clinical picture, severe pulmonary stenosis can cause a systolic murmur that might be considered in the differential diagnosis of systolic murmurs, albeit less likely in this context.