Aortic regurgitation results in regurgitation of blood from the aorta back into the left ventricle during diastole. This results in increased left ventricular end-diastolic volume.
Character: Early diastolic (sounds like a breath)
Best heard: upper right sternal edge (or lower left sternal edge sitting forwards); loudest on expiration
Connective tissue disorders (e.g. Marfan syndrome, ankylosing spondylitis, Ehlers–Danlos syndrome) – may also cause aortic root dilatation
Rheumatic heart disease
Congenital/bicuspid aortic valve
Mitral stenosis
Mitral stenosis murmur
Mitral stenosis causes increased resistance between left atrium and left ventricle. This results in high left atrial pressure and subsequent pulmonary hypertension.
Character: low rumbling mid-diastolic with opening snap
Best heard: apex in left lateral position; loudest on expiration using bell of stethoscope
Radiation: none
Symptoms:
Dyspnoea
Fatigue
Haemoptysis
Chest pain
Signs:
Malar flush (due to low cardiac output)
AF
Tapping apex (palpable S1)
Loud S1
Signs of pulmonary hypertension (RV heave, loud P2)
Causes of… Mitral stenosis
Rheumatic heart disease
Others causes rare (e.g. congenital, carcinoid)
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