Valvular heart disease

Clinical examination findings

 MRCP  PACES  Cardiology

mitral stenosismitral regurgitationaortic stenosisaortic regurgitationventricular septal defect
inspectionMalar flush, left thoracotomy scarleft thoracotomy scarMarfanoid features, ankylosing spondylitisyoung patient may be a clue
pulseAFregularslow-rising pulse, small volume. Brachioradial delay.'collapsing' pulseregular
JVPGiant 'v' waves may be seen (tricuspid regurgitation)usually not raisedusually not raisedCorrigan's signusually not raised
chestTapping apex beat, left parasternal heavedisplaced apex beat, left parasternal heavesustained heave, systolic thrillthrusting displaced apex beatleft parasternal heave, apex may be displaced, may have a systolic thrill
auscultationLoud 1st heart sound (and pulmonary second sound), opening snap, mid-diastolic murmur at apex in left lateral positionsoft 1st heart sound with loud pan-systolic murmur radiating to axilla. May have a 3rd heart sound.ejection systolic murmur radiating to the carotids, soft second heart soundearly diastolic murmur loudest in expiration leaning forwardpan-systolic murmur left lower sternal edge and apex
causes to considerrheumatic heart diseasemitral valve prolapse, previous valvotomy, infective endocarditisrheumatic heart diseaseMarfan syndromeDown syndrome, Turner's
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These features help differentiate between the common cardiac valve / septal pathologies. Remember also to examine for signs of cardiac failure.


Eponymous cardiac murmurs | Endocarditis | Renal tubular acidosis types | Oligomenorrhoea and amenorrhoea | Emphysema | Hypertensive retinopathy | Jaundice | Granulomatous mycobacterial infections of the skin | Familial hyperlipidaemias | Hyperparathyroidism classification | Chest pain | Motor defects | Chest examination | Inflammatory bowel disease | Cutaneous infestations | Loss of consciousness | Hyponatraemia |