Physical findings in mitral regurgitation and aortic stenosis
THE CONTEXT
The target contains a description of mitral regurgitation followed by an interpretable figure caption describing aortic stenosis.
Mitral regurgitation: murmur location
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The direction of the regurgitant jet influences where the murmur is heard best: posterior leaflet prolapse is often best heard in the anterior precordium, while anterior leaflet prolapse is best heard into the axilla.
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Functional regurgitation usually produces an apical pansystolic murmur radiating into the axilla; a thrill may accompany it.
Mitral regurgitation: ventricular filling and apex beat
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Increased forward flow through the mitral valve causes a loud third heart sound and may produce a short mid-diastolic murmur.
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Left ventricular volume overload produces an active, rocking apex beat. Left ventricular dilatation usually displaces it.
Aortic stenosis
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Pressure traces show a systolic gradient between the left ventricle and aorta.
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The diamond-shaped murmur is heard best with the diaphragm in the aortic outflow and at the apex.
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An ejection click may occur in young patients with a bicuspid aortic valve, but not in older patients with calcified valves.
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Aortic stenosis may cause left ventricular hypertrophy with an apical fourth heart sound and post-stenotic dilatation of the aortic arch.