Mitral stenosis differential diagnosis

Mitral Stenosis Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2];Yamuna Kondapally, M.B.B.S[3]

Overview

The possible causes, and other conditions that may present similarly, should be evaluated for when there is suspicion of mitral stenosis.

Differentiating Mitral Stenosis from other Diseases

Mitral stenosis must be differentiated from the following:

Diseases	History and Symptoms	Physical Examination	Murmur	Diagnosis				Other Findings
				ECG	CXR	Echocardiogram	Cardiac Catheterization
Mitral Stenosis	History • Age ( Mitral annular calcification in older patients) • Rheumatic fever • Endocarditis Symptoms • Dyspnea on exertion • Paroxysmal nocturnal dyspnea • Orthopnea • New onset atrial fibrillation	• Mitral facies • Heart murmur • Jugular vein distension • Apical impulse displaced laterally or not palpable • Diastolic thrill at the apex • Signs of heart failure in severe cases	• Diastolic murmur • Low pitched • Opening snap followed by decrescendo-crescendo rumbling murmur • Best heard with the bell of the stethoscope at apex at end-expiration in left lateral decubitus position • Intensity increases after a valsalva manuever, after exercise and after increased afterload (eg., squatting, isometric handgrip)	• P mitrale • Atrial fibrillation: No P waves and irregularly irregular rhythm • Right axis deviation • Right ventricular hyppertropy: Dominant R wave in V1 and V2				• Heamoptysis • Ortner's syndrome
Mitral Regurgitation			• Holosystolic murmur • High pitched, blowing • Radiates to axilla • Best heard with the diaphragm of the stethoscope at apex in left lateral decubitus position • Intensity increases with hand grip or squatting • Decrease in intensity on standing or valsalva maneuver
Atrial Septal Defect			• Midsystolic (ejection systolic) murmur • Widely split, fixed S2 • Upper left sternal border
Left Atrial Myxoma			• Early diastolic sound as "tumor plop" • Low frequency diastolic murmur may be heard if the tumor obstructing mitral valve
Prosthetic Valve Obstruction			• Muffling or disappearance of prosthetic sounds • appearance of new regurgitant or obstructive murmur
Cor Triatriatum			• Diastolic murmur with loud P2 • No opening snap or loud a loud S1
Congenital Mitral Stenosis			Mild-Moderate • Loud S1 • Loud P2 • Low frequency diastolic murmur best heard at the apex Severe • Soft S1 • Loud pulmonic component of S2 with minimal respiratory splitting of S2 • Holodiastolic murmur with presystolic accentuation best heard at the apex. • Early diastolic murmur of pulmonic valve regurgitation
Supravalvular Ring Mitral Stenosis			• An apical mid diastolic murmur with presystolic accentuation • No opening snap • The murmur is more prominent if associated with VSD or PDA