Valve Disorders: Aortic vs Mitral — Stenosis and Regurgitation Patterns
A systolic murmur could be aortic stenosis or mitral regurgitation — but the location, radiation, and symptoms point to completely different pathology and urgency. Picking the wrong valve on the NCLEX means misidentifying the surgical candidate and choosing the wrong priority assessment.
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- Stenosis: LV pressure overload, LVH
- Regurg: LV volume overload, dilation
- Calcific degeneration, bicuspid valve
- Stenosis: LA dilation, pulm congestion
- Regurg: LA + LV volume overload
- Rheumatic disease, prolapse, post-MI
- ★Stenosis: harsh systolic, RUSB → neck
- Regurg: diastolic blowing decrescendo
- Stenosis triad: syncope, angina, dyspnea
- ★Stenosis: diastolic rumble, opening snap
- Regurg: holosystolic blowing at apex
- Stenosis: dyspnea, hemoptysis, A-fib
- Echo grades severity
- LVH on ECG
- Echo grades severity
- LA enlargement, A-fib on ECG
- ★Avoid vasodilators in severe stenosis
- Monitor exertional syncope
- Caution with nitrates, diuretics
- ★Monitor for A-fib, thromboembolism
- Assess for hemoptysis, crackles
- Anticoagulate if A-fib
- Stenosis: valve replacement (TAVR/SAVR)
- Mech. valve: warfarin INR 2–3
- Stenosis: balloon valvotomy/replacement
- Mech. valve: warfarin INR 2.5–3.5
- Report syncope, chest pain, dyspnea
- Warfarin: INR checks, bleeding signs
- Dental antibiotic ppx if prosthetic valve
- Report palpitations (A-fib)
- Warfarin: INR checks, bleeding signs
- Dental antibiotic ppx if prosthetic valve
- Syncope or chest pain on exertion
- Acute pulmonary edema
- New A-fib with rapid rate
- Acute pulmonary edema
- Left heart failure, sudden cardiac death
- A-fib, LA thrombus, embolic stroke
- Pulmonary HTN → right HF
Aortic Valve Disorders
- Stenosis: LV pressure overload, LVH
- Regurg: LV volume overload, dilation
- Calcific degeneration, bicuspid valve
Mitral Valve Disorders
- Stenosis: LA dilation, pulm congestion
- Regurg: LA + LV volume overload
- Rheumatic disease, prolapse, post-MI
Aortic Valve Disorders
- ★Stenosis: harsh systolic, RUSB → neck
- Regurg: diastolic blowing decrescendo
- Stenosis triad: syncope, angina, dyspnea
Mitral Valve Disorders
- ★Stenosis: diastolic rumble, opening snap
- Regurg: holosystolic blowing at apex
- Stenosis: dyspnea, hemoptysis, A-fib
Aortic Valve Disorders
- Echo grades severity
- LVH on ECG
Mitral Valve Disorders
- Echo grades severity
- LA enlargement, A-fib on ECG
Aortic Valve Disorders
- ★Avoid vasodilators in severe stenosis
- Monitor exertional syncope
- Caution with nitrates, diuretics
Mitral Valve Disorders
- ★Monitor for A-fib, thromboembolism
- Assess for hemoptysis, crackles
- Anticoagulate if A-fib
Aortic Valve Disorders
- Stenosis: valve replacement (TAVR/SAVR)
- Mech. valve: warfarin INR 2–3
Mitral Valve Disorders
- Stenosis: balloon valvotomy/replacement
- Mech. valve: warfarin INR 2.5–3.5
Aortic Valve Disorders
- Report syncope, chest pain, dyspnea
- Warfarin: INR checks, bleeding signs
- Dental antibiotic ppx if prosthetic valve
Mitral Valve Disorders
- Report palpitations (A-fib)
- Warfarin: INR checks, bleeding signs
- Dental antibiotic ppx if prosthetic valve
Aortic Valve Disorders
- Syncope or chest pain on exertion
- Acute pulmonary edema
Mitral Valve Disorders
- New A-fib with rapid rate
- Acute pulmonary edema
Aortic Valve Disorders
- Left heart failure, sudden cardiac death
Mitral Valve Disorders
- A-fib, LA thrombus, embolic stroke
- Pulmonary HTN → right HF
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Systolic + syncope = aortic stenosis. Diastolic rumble + A-fib = mitral stenosis. Timing + symptoms name the valve.
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Go further
- TopicAortic Valve DisordersThe loudest murmur in the chest doesn't always mean the worst valve — but a shrinking pulse pressure on an aortic stenosis patient signals that the heart is losing the fight.
- TopicMitral Valve DisordersThe mitral valve sits between the two left-sided chambers, and when it fails — whether it won't open or won't close — blood backs up into the lungs before the patient ever notices…
- Commonly confusedAtrial Fibrillation vs Atrial FlutterIrregular chaos vs organized sawtooth — rate, rhythm, and stroke risk compared.
- Commonly confusedDVT vs Pulmonary EmbolismClot in the leg vs clot in the lung — one can become the other.