differential diagnosis

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The differential diagnosis for mitral stenosis includes:

  • atrial fibrillation without mitral stenosis

  • primary pulmonary hypertension

  • a left to right shunt:
    • atrial septal defect - the dilated right ventricle may reach the axilla causing apical short ventricular filling murmurs because of high flow through the tricuspid valve
    • ventricular septal defect, patent ductus arteriosus - these conditions may cause mitral flow murmurs

  • Austin Flint murmur:
    • the murmur of mitral stenosis may be indistinguishable from the Austin Flint murmur of pure aortic regurgitation
    • mitral stenosis usually has a loud first heart sound which is absent in aortic regurgitation
    • a definite diagnosis may require echocardiography

  • left atrial myxoma:
    • the tumour may lie in the mitral orifice and so is sometimes misdiagnosed as mitral stenosis
    • frequently there are systemic emboli
    • diagnosis is made via histology of an embolus or by echocardiography

  • Carey-Coombs murmur:
    • this is a variable, high-pitched mid-diastolic murmur heard during the acute valvulitic phase of rheumatic fever

Last reviewed 01/2018

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