Podcast Episode 92: Murmurs Made Incredibly Easy (Part 2 of 5) – Mitral Stenosis and Regurgitation

Welcome to episode 92 of the Audio PANCE and PANRE physician assistant/associate board review podcast.

Today is part two of this extraordinary five-part series with Joe Gilboy PA-C, all about cardiac murmurs. In this week’s episode of the Audio PANCE and PANRE podcast, we continue our discussion of cardiac murmurs with a focus on the mitral valve.

We’ll talk about the different types of murmurs (stenosis and regurgitation) that can occur with this valve and how to differentiate them from other types of murmurs. If you haven’t already, make sure to listen to our previous podcast episode where we covered the aortic valve murmurs.

The Mitral Valve

The mitral valve is located between the left atrium and the left ventricle in the heart. It consists of two leaflets (or cusps) and is responsible for preventing blood from flowing back into the atrium when the ventricle contracts.

The mitral valve can have two types of murmurs: stenosis and regurgitation.

* Mitral stenosis is a narrowing (or constriction) of the valve opening, which reduces the amount of blood that can flow through the valve. This type of murmur is of low pitch, rumbling in character, and best heard at the apex with the patient in the left lateral position.* Mitral regurgitation is a leakage (or backflow) of blood from the ventricle into the atrium, caused by weakened or damaged valve leaflets. This type of murmur is a holosystolic (pansystolic) murmur, heard best at the apex with the diaphragm of the stethoscope when the patient is in the left lateral decubitus position.

In addition to auscultation, you can also look for certain signs and symptoms that may indicate mitral stenosis or regurgitation. For example, if a patient presents with chest pain (angina pectoris), this could be from decreased oxygen supply due to poor cardiac output in cases of significant stenosis. On the other hand, if a patient presents with an irregular heart rate (arrhythmia), this could be from increased electrical conduction velocity in cases of significant regurgitation.

Also, keep in mind that mitral valve disease can also occur secondary to rheumatic fever or endocarditis, so you may need to consider these diagnoses if a patient has any of the aforementioned signs and symptoms.

Below is a transcription of this podcast episode edited for clarity.

* You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher,