Differentials
Mitral stenosis
SIGNS / SYMPTOMS
Malar flush, low volume pulse, a tapping and undisplaced apex beat, and loud S1 with an opening snap.
The murmur is rumbling and mid-diastolic.
INVESTIGATIONS
CXR: pulmonary oedema, enlarged left atrium, and mitral valve calcification.
ECG: can present with atrial fibrillation. Right ventricular hypertrophy may also be present.
Echocardiogram: diagnostic for mitral stenosis.
Aortic regurgitation (AR)
SIGNS / SYMPTOMS
In mild AR the murmur is early diastolic, and increases in duration to holodiastolic in severe AR.
A diastolic murmur may be absent in acute AR.
INVESTIGATIONS
CXR: may show cardiomegaly in the leftward and inferior direction in chronic AR.
ECG: may show non-specific ST-T wave changes, left axis deviation, or conduction abnormalities.
Echocardiogram: visualisation of the origin of regurgitant jet and its width; detection of cause of aortic valve pathology.
Atrial myxoma
SIGNS / SYMPTOMS
The murmur is mid-late diastolic, and changes in character and intensity with alterations in position.
INVESTIGATIONS
Echocardiogram: visualisation of a mass, usually attached to the interatrial septum or free wall of the atrium.
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