Mixed Valve Disease 2018-01-30T16:37:48+00:00
  • Identify the predominant lesion
  • Predominant lesion will have clinical signs associated with severity of that lesion
  • Aortic stenosis
    • Low-volume pulse
    • Slow-rising pulse
    • Narrow pulse pressure
    • Heaving apex beat (left ventricular hypertrophy)
    • Thrill over the aortic area
    • Soft S2
    • S4
    • Late-peaking ejection systolic murmur
    • Signs of left ventricular failure
    • Signs of pulmonary hypertension
  • Aortic regurgitation
    • Collapsing pulse
    • Wide pulse pressure
    • Displaced apex beat
    • S3
    • Austin-Flint murmur
    • Very short (rapid equalization of aortic and ventricular pressures) or very long murmur
    • Signs of left ventricular failure
    • Signs of pulmonary hypertension
  • Mitral stenosis
    • Early opening snap
    • Long diastolic murmur
    • Graham-Steele murmur of pulmonary regurgitation
    • Signs of pulmonary hypertension
  • Mitral regurgitation
    • Displaced apex beat
    • Palpable thrill over mitral area
    • Soft S1
    • Widely-split S2 (large regurgitant volume, resulting in earlier aortic valve closure)
    • Diastolic murmur (increased flow across the mitral valve)
    • Signs of pulmonary hypertension
    • Signs of left heart failure

Causes of mixed valve disease

  • Rheumatic heart disease
  • Infective endocarditis
  • Bicuspid aortic valve (mixed aortic valve disease only)
  • Mitral stenosis with mitral valvotomy complicated by mitral regurgitation (mixed mitral valve disease only)

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