Severe Mitral Stenosis Lesson #690

The patient was supine left side down during auscultation.

Description

In this example of severe mitral stenosis, notice that the first heart sound has decreased intensity due to severe thickening of the mitral valve leaflets. The second heart sound is normal and unsplit, and systole is silent. An opening snap occurs 50 milliseconds into diastole. As mitral stenosis becomes more severe, the opening snap will occur earlier in diastole. The opening snap is followed by a low-frequency murmur which occupies the remainder of diastole. The first two-thirds of the murmur is diamond-shaped and the remainder is a crescendo.

Use the bell of the stethoscope to hear this murmur.

In the cardiac animation video, observe the turbulent blood flow from the left atrium into the left ventricle. Also notice the severely thickened mitral valve leaflets and the markedly enlarged left atrium. The excursion of the mitral valve leaflets is severely reduced. Mitral stenosis is commonly caused by rheumatic heart disease.