Mitral stenosis vs Mitral regurgitation
How to tell Mitral stenosis and Mitral regurgitation apart when a board question makes them look alike.
Step 2 CK pairs are in open beta while clinical review finishes. Spot an issue? Tell us.
Murmur timing at the apex separates them immediately, with diastolic rumble for mitral stenosis versus holosystolic axillary-radiating murmur for mitral regurgitation.
Side by side
A low-pitched diastolic rumble with opening snap at the apex indicates mitral stenosis.
A holosystolic blowing murmur at the apex radiating to the axilla indicates mitral regurgitation.
Narrowing of the mitral valve obstructs left atrial emptying and raises left atrial and pulmonary pressures.
Incomplete mitral leaflet closure causes systolic backflow into the left atrium and progressive volume overload.
Echocardiography in significant mitral stenosis shows mitral valve area at or below about 1.5 cm2, elevated mean transmitral gradient, and often left atrial enlargement with pulmonary hypertension signs.
Echocardiography in mitral regurgitation shows regurgitant jet with parameters such as effective regurgitant orifice area at least 0.40 cm2 for severe disease, vena contracta at least 0.7 cm, or regurgitant volume at least 60 mL per beat.
The trap
Learners may call any apical murmur mitral regurgitation and overlook opening snap plus diastolic rumble. They also miss that acute severe regurgitation with pulmonary edema is a surgical emergency, unlike many chronic compensated cases.
The repair move
Next best step: identify murmur timing, then confirm with transthoracic echocardiography to define severity and hemodynamics. For symptomatic mitral stenosis, start diuretics for congestion and rate control if atrial fibrillation is present, anticoagulate when indicated, and evaluate for percutaneous balloon mitral valvotomy when valve anatomy is favorable. For severe symptomatic mitral regurgitation, especially acute pulmonary edema or cardiogenic shock, stabilize with afterload reduction and urgent surgical consultation.
Try a free question
CoreA 52-year-old patient has progressive exertional dyspnea. Exam shows an opening snap followed by a low-pitched diastolic rumble at the apex. What is the most likely diagnosis?
Show answer and explanation
Answer: A. Mitral stenosis. The classic opening snap and apical diastolic rumble identify mitral stenosis.
Why the other choices are tempting
- B. Wrong because mitral regurgitation causes a holosystolic murmur, not a diastolic rumble with opening snap.
- C. Wrong because aortic regurgitation produces a high-pitched decrescendo diastolic murmur along the left sternal border.
- D. Wrong because tricuspid regurgitation is holosystolic at the left lower sternal border and accentuates with inspiration.
- E. Wrong because hypertrophic cardiomyopathy usually has a systolic crescendo-decrescendo murmur that changes with preload.
Flashcards
Tap a card to flip it.
Which auscultation timing clue best distinguishes mitral stenosis from mitral regurgitation?
Mitral stenosis is diastolic with opening snap, while mitral regurgitation is holosystolic and radiates toward the axilla.
What echocardiographic valve area threshold commonly marks severe mitral stenosis?
A mitral valve area around 1.5 cm2 or less indicates clinically significant stenosis, with lower values indicating greater severity.
Quick answers
What is the fastest way to tell Mitral stenosis from Mitral regurgitation?
Murmur timing at the apex separates them immediately, with diastolic rumble for mitral stenosis versus holosystolic axillary-radiating murmur for mitral regurgitation.
What is the key clue for Mitral stenosis?
A low-pitched diastolic rumble with opening snap at the apex indicates mitral stenosis.
What is the key clue for Mitral regurgitation?
A holosystolic blowing murmur at the apex radiating to the axilla indicates mitral regurgitation.
What is the common trap with Mitral stenosis vs Mitral regurgitation?
Learners may call any apical murmur mitral regurgitation and overlook opening snap plus diastolic rumble. They also miss that acute severe regurgitation with pulmonary edema is a surgical emergency, unlike many chronic compensated cases.