What are the signs of mitral stenosis, aortic stenosis, aortic regurgitation, and mitral regurgitation?

Signs of Common Valvular Heart Diseases

The three most characteristic signs of each valvular disease are the specific auscultatory findings, hemodynamic consequences, and physical manifestations that directly reflect the underlying pathophysiology.

Mitral Stenosis

1. Opening snap followed by a low-pitched diastolic rumble - This characteristic auscultatory finding is heard best at the apex with the patient in the left lateral position 1
2. Tachycardia-induced pulmonary congestion - Reduced diastolic filling period with faster heart rates leads to severe pulmonary congestion, a key hemodynamic consequence 1
3. Atrial fibrillation - Common finding due to left atrial enlargement and pressure overload, contributing to further hemodynamic compromise 1

Aortic Stenosis

1. Late-peaking systolic ejection murmur - Crescendo-decrescendo murmur heard best at the right upper sternal border that may radiate to the carotids 1
2. Diminished/delayed carotid upstroke (pulsus parvus et tardus) - Reflects the obstruction to left ventricular outflow 1
3. Absent or diminished aortic component of S2 - Due to reduced mobility of the calcified aortic valve 1

Aortic Regurgitation

1. Early diastolic decrescendo murmur - Heard best at the left sternal border with patient leaning forward and holding breath after expiration 1
2. Widened pulse pressure with bounding peripheral pulses - Reflects the rapid rise and fall in arterial pressure due to regurgitation 1
3. Tachycardia is beneficial - Unlike mitral stenosis, faster heart rates reduce regurgitation volume by shortening diastole 1

Mitral Regurgitation

1. Apical holosystolic murmur - Radiating to the axilla, reflecting blood flow from left ventricle to left atrium throughout systole 1
2. Third heart sound (S3) - Often present due to volume overload of the left ventricle 1
3. Diastolic flow rumble - Accompanies severe mitral regurgitation due to increased flow across the mitral valve in diastole 1

Important Clinical Considerations

• Echocardiographic correlation: While these physical signs are characteristic, echocardiography with Doppler is essential for confirming diagnosis and quantifying severity 1

• Hemodynamic impact: The severity of symptoms often correlates with the degree of hemodynamic compromise, which varies by valve lesion 1

• Mixed valve disease: Multiple valve lesions may coexist, complicating the clinical picture and requiring careful assessment of each component 2, 3

• Pitfall to avoid: Relying solely on echocardiography without correlating with clinical findings can lead to misdiagnosis. For example, an eccentric mitral regurgitation jet may appear mild on echocardiography despite severe clinical manifestations 1

• Caveat: Normal pregnancy can mimic some findings of valvular disease, including systolic murmurs and physiologic mitral regurgitation on Doppler, highlighting the importance of comprehensive clinical assessment 1