Patients with combined valvular disease generally present at a younger age than those with a single chronic lesion. The most common symptom of combined valvular disease is dyspnea. Symptoms of multivalvular disease may resemble those of single-valve disease when advanced disease of one valve dominates the clinical picture. Although both syncope and angina pectoris are infrequent in patients with mitral regurgitation alone, chest pain and syncope are more common with incompetence of both the aortic and mitral valves. The presence of a chronic lesion of one valve exaggerates the effects of an acute lesion of another valve.
Physical signs are more difficult to interpret in mixed lesions. With combined aortic and mitral stenosis, the aortic systolic murmur is reduced. The mitral opening snap is infrequently audible in this setting. In regurgitant lesions of both aortic and mitral valves, the usual fall in diastolic blood pressure commonly seen with aortic incompetence may be absent. As many as 40 percent of patients with this combined valvular disease have diastolic blood pressures above 70 mmHg.
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