7 Mixed mitral and aortic valve disease
Salient features
• Pulse may be small volume (from either dominant aortic stenosis or mitral stenosis), regular or irregularly irregular
• Mid-diastolic murmur of mitral stenosis
• Pansystolic murmur of mitral regurgitation
• Ejection systolic murmur of aortic stenosis at the base of the heart
• Early diastolic murmur of aortic regurgitation heard with the patient sitting forward on end expiration.
Note
• If the apex beat is not displaced in such mixed lesions, then mitral stenosis is the dominant lesion. (However, if the mitral stenosis developed earlier it can mask the signs of a significant stenosis.)
• In aortic stenosis, the murmur of mitral stenosis may be diminished or absent. The presence of the following features should alert the clinician to a coexisting mitral stenosis because they are not commonly associated with isolated aortic stenosis:
