Mitral regurgitation vs Mitral stenosis
How to tell Mitral regurgitation and Mitral stenosis apart when a board question makes them look alike.
MR: blowing holosystolic apical murmur radiating to the axilla; MS: low-pitched mid-diastolic rumble after an opening snap.
Side by side
Holosystolic murmur at the apex radiating to the axilla.
Opening snap followed by a low-pitched diastolic rumble at the apex.
Blood leaks backward from left ventricle to left atrium during systole.
Narrow mitral valve obstructs left atrial emptying during diastole.
Acute MR can follow papillary muscle rupture or chordae rupture.
Rheumatic valve disease, left atrial enlargement, and a shorter A2-opening snap interval with more severe stenosis support MS.
The trap
Atrial fibrillation, dyspnea, and a loud apical murmur appear in both. Neither picks the valve. Timing the murmur in the cardiac cycle (systole vs diastole) and listening for an opening snap (MS only) are the deciding bedside calls. The shorter the A2-to-opening-snap interval, the more severe the MS.
Watch it explained
The repair move
For murmurs, timing beats location; systole vs diastole is the first fork, then use radiation or opening snap details.
Try a free question
CoreA patient develops a holosystolic murmur best heard at the apex that radiates to the axilla after myocardial infarction. Which valve lesion is most likely?
Show answer and explanation
Answer: A. Mitral regurgitation. Holosystolic apical murmur radiating to the axilla points to mitral regurgitation.
Why the other choices are tempting
- B. Mitral stenosis is a diastolic opening snap and rumble.
- C. Aortic stenosis is a systolic ejection murmur radiating to the carotids.
- D. Aortic regurgitation is an early diastolic decrescendo murmur.
- E. Tricuspid stenosis is a diastolic murmur that increases with inspiration.
Flashcards
Tap a card to flip it.
What murmur timing separates MR from MS?
Mitral regurgitation is holosystolic; mitral stenosis is a diastolic rumble after an opening snap.
Why does mitral regurgitation radiate to the axilla?
Systolic backflow from the left ventricle into the left atrium creates the apical holosystolic leak pattern.
Quick answers
What is the fastest way to tell Mitral regurgitation from Mitral stenosis?
MR: blowing holosystolic apical murmur radiating to the axilla; MS: low-pitched mid-diastolic rumble after an opening snap.
What is the key clue for Mitral regurgitation?
Holosystolic murmur at the apex radiating to the axilla.
What is the key clue for Mitral stenosis?
Opening snap followed by a low-pitched diastolic rumble at the apex.
What is the common trap with Mitral regurgitation vs Mitral stenosis?
Atrial fibrillation, dyspnea, and a loud apical murmur appear in both. Neither picks the valve. Timing the murmur in the cardiac cycle (systole vs diastole) and listening for an opening snap (MS only) are the deciding bedside calls. The shorter the A2-to-opening-snap interval, the more severe the MS.