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.
Comparison
- Stenosis → LV pressure overload, hypertrophy
- Regurg → LV volume overload + dilation
- Calcific degeneration, bicuspid valve
- Stenosis → LA dilation, pulmonary congestion
- Regurg → LA & LV volume overload
- Rheumatic disease, prolapse, post-MI
- ★Stenosis: systolic crescendo-decrescendo, RUSB→carotids
- Regurg: diastolic blowing decrescendo
- Stenosis triad: syncope, angina, dyspnea
- ★Stenosis: diastolic rumble + opening snap, apex→axilla
- Regurg: holosystolic blowing at apex
- Stenosis: dyspnea, hemoptysis, A-fib
- Echo grades severity, area, gradient; LVH on ECG
- Regurg surgery: LVEF/LVESD criteria
- Echo grades severity; LA enlargement/A-fib on ECG
- Regurg surgery: LVEF <60% or LVESD ≥40 mm
- ★Avoid vasodilators in severe stenosis
- Monitor exertional syncope; caution preload-lowering
- ★Monitor for A-fib, thromboembolism
- Assess lung sounds; anticoagulate per order
- Stenosis: valve replacement (TAVR/SAVR)
- Mechanical valve → lifelong warfarin INR 2–3
- Stenosis: balloon valvotomy/replacement
- Mechanical valve → warfarin INR 2.5–3.5
- Report syncope, chest pain, dyspnea
- Warfarin: INR checks, diet, bleeding signs
- Endocarditis ppx before dental if prosthetic
- Syncope or chest pain on exertion
- Acute decompensated heart failure
- New A-fib with rapid rate
- Acute pulmonary edema
- Left heart failure, sudden cardiac death
- A-fib, LA thrombus, embolic stroke
- Pulmonary hypertension → right HF
Aortic Valve Disorders
- Stenosis → LV pressure overload, hypertrophy
- Regurg → LV volume overload + dilation
- Calcific degeneration, bicuspid valve
Mitral Valve Disorders
- Stenosis → LA dilation, pulmonary congestion
- Regurg → LA & LV volume overload
- Rheumatic disease, prolapse, post-MI
Aortic Valve Disorders
- ★Stenosis: systolic crescendo-decrescendo, RUSB→carotids
- Regurg: diastolic blowing decrescendo
- Stenosis triad: syncope, angina, dyspnea
Mitral Valve Disorders
- ★Stenosis: diastolic rumble + opening snap, apex→axilla
- Regurg: holosystolic blowing at apex
- Stenosis: dyspnea, hemoptysis, A-fib
Aortic Valve Disorders
- Echo grades severity, area, gradient; LVH on ECG
- Regurg surgery: LVEF/LVESD criteria
Mitral Valve Disorders
- Echo grades severity; LA enlargement/A-fib on ECG
- Regurg surgery: LVEF <60% or LVESD ≥40 mm
Aortic Valve Disorders
- ★Avoid vasodilators in severe stenosis
- Monitor exertional syncope; caution preload-lowering
Mitral Valve Disorders
- ★Monitor for A-fib, thromboembolism
- Assess lung sounds; anticoagulate per order
Aortic Valve Disorders
- Stenosis: valve replacement (TAVR/SAVR)
- Mechanical valve → lifelong warfarin INR 2–3
Mitral Valve Disorders
- Stenosis: balloon valvotomy/replacement
- Mechanical valve → warfarin INR 2.5–3.5
Aortic Valve Disorders
- Report syncope, chest pain, dyspnea
- Warfarin: INR checks, diet, bleeding signs
Mitral Valve Disorders
- Endocarditis ppx before dental if prosthetic
Aortic Valve Disorders
- Syncope or chest pain on exertion
- Acute decompensated heart failure
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 hypertension → right HF
★ marks the fact that sets a column apart.
Clinical Pearl
Systolic + syncope = aortic stenosis. Diastolic rumble + A-fib = mitral stenosis. Timing + symptoms name the valve.
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