Cardiology: valvular heart disease — murmurs, diagnosis and management
RezzyValvular heart disease is a huge part of cardiology and a favorite for the USMLE! It basically boils down to two problems: the valve doesn't open enough (stenosis) or it doesn't close properly (regurgitation).
To get us started, I've put together a quick reference table for the "Big Four" murmurs you'll definitely see on your exams.
| Valve Lesion | Timing | Description | Key Physical Exam Findings |
|---|---|---|---|
| Aortic Stenosis (AS) | Systolic | Crescendo-decrescendo | Radiates to carotids; Pulsus parvus et tardus |
| Mitral Regurgitation (MR) | Systolic | Holosystolic, blowing | Radiates to axilla; often post-MI or MVP |
| Aortic Regurgitation (AR) | Diastolic | Early decrescendo, blowing | Wide pulse pressure; Water-hammer pulse |
| Mitral Stenosis (MS) | Diastolic | Mid-to-late rumbling | Opening snap; often due to Rheumatic Fever |
That table covers the basics, but there's a lot more to management—like knowing when to move from medical therapy to surgical intervention (TAVR vs. SAVR for Aortic Stenosis, for example).
Let me find some detailed lessons that break down the diagnostic algorithms and management guidelines for you.
📚 Valvular Heart Disease Lessons
Those lessons will give you the deep dive you need for the pathophysiology and management.
One of the trickiest parts of these questions is identifying the murmur based on where the stethoscope is placed. I'll pull up a diagram showing the classic auscultation points to help you visualize where each valve is best heard.
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