Valvular heart disease encompasses stenosis (restricted opening, obstructed flow) and regurgitation (incomplete closure, backward flow) of the four heart valves. Aortic stenosis is the most common valvular disease in elderly patients — progressive calcification of a tricuspid (senile) or bicuspid (congenital) aortic valve narrows the valve orifice, creating a pressure gradient between the LV and aorta. The classic murmur is a crescendo-decrescendo systolic murmur heard best at the right upper sternal border, radiating to the carotids, with a late-peaking murmur indicating severe stenosis. The symptom triad (SAD) — syncope, angina, dyspnea — marks the onset of clinical decline; once symptoms appear, average survival without valve replacement is 2-3 years (5 years for angina, 3 years for syncope, 2 years for heart failure). Mitral regurgitation is caused by mitral valve prolapse, ischemic papillary muscle dysfunction, or rheumatic disease. The murmur is a holosystolic (pansystolic) high-pitched blowing murmur at the apex, radiating to the axilla. Echocardiography quantifies severity: valve area, pressure gradients, regurgitant volume, and ventricular dimensions guide surgical timing. The NP must differentiate murmurs by timing, location, radiation, maneuvers, and grade...