Mitral Regurgitation vs Mitral Stenosis
Mitral Regurgitation and Mitral Stenosis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Mitral Regurgitation vs Mitral Stenosis at a glance
- Mitral Regurgitation: Backflow of blood from LV to LA in systole; acute presents catastrophically, chronic insidiously.
- Mitral Stenosis: Obstruction to LV inflow at the mitral valve — almost always rheumatic; opening snap with diastolic rumble.
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Side-by-side comparison
| Feature | Mitral Regurgitation | Mitral Stenosis |
|---|---|---|
| At a glance | Backflow of blood from LV to LA in systole; acute presents catastrophically, chronic insidiously. | Obstruction to LV inflow at the mitral valve — almost always rheumatic; opening snap with diastolic rumble. |
| Classic presentation | Acute MR (papillary muscle rupture, endocarditis with cordal rupture):; • Sudden severe dyspnea, flash pulmonary edema, cardiogenic shock; • Hypotension,… | Progressive exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea; Fatigue from low cardiac output; Hemoptysis (pulmonary venous hypertension, ruptured… |
| Workup / key labs | BNP, BMP, troponin (if acute presentation), blood cultures (if endocarditis suspected) | Severe MS: mitral valve area ≤1.5 cm² (very severe ≤1.0), mean transmitral gradient >5-10 mmHg at heart rate 60-80, pulmonary artery systolic pressure >50… |
| Imaging | ECG: LA enlargement (broad notched P in lead II — 'P mitrale'), LVH, AFib in chronic MR; CXR: cardiomegaly (LA enlargement causes elevation of left main… | Transthoracic echo — diagnostic; planimetry of mitral valve area, mean gradient, pulmonary artery pressure, Wilkins score for valvuloplasty candidacy;… |
| First-line treatment | Acute severe MR — surgical emergency:; • Stabilize: afterload reduction with IV nitroprusside or nitroglycerin, intra-aortic balloon pump if shock; • Diuresis… | Diuretics (furosemide, torsemide) for pulmonary and systemic congestion; Rate control for Afib: beta-blocker (metoprolol, bisoprolol) or non-dihydropyridine… |
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