Clinical Presentation of different Cardiac Valvular diseases

Mitral stenosis
• Symptoms: dyspnea, cough productive of frothy (pink?) sputum,
palpitations (often associated with AF and resultant emboli)
• Signs: palmar erythema, malar fl ush, “tapping” apex beat, left
parasternal heave, loud S 1 , mid-diastolic murmur 9 opening snap

Mitral regurgitation
• Symptoms: acute dyspnea and pulmonary congestion
• Signs: collapsing pulse, sustained apex beat displaced to the left, left
parasternal heave, soft S 1 , loud S 2 (pulmonary component), pansystolic
murmur heard at the apex radiating to left axilla ± mid-systolic click,
third heart sound

Aortic stenosis
• Symptoms: angina, syncope, dyspnea, sudden death
• Signs: Slow rising pulse, low blood pressure, narrow pulse pressure,
sustained and powerful apex beat, ejection systolic murmur radiating
to carotids, soft S 2 , 9 ejection click

Aortic regurgitation
• Symptoms: similar to aortic stenosis
• Signs: collapsing pulse, wide pulse pressure, sustained and displaced
apex beat, soft S 2 , early diastolic murmur at the left sternal edge (often
described as “blowing” or decrescendo), 9 ejection systolic murmur
(i volume). You may also hear a “pistol shot” sound over the femoral
artery with severe aortic regurgitation. See also Box 7.6 .

Tricuspid stenosis
This usually occurs along with mitral or aortic valvular disease (e.g., in
rheumatic fever) and is often the less serious of the patient’s problems.
• Signs: auscultation similar to that of mitral stenosis, hepatomegaly,
pulsatile liver, and venous congestion