Diastolic Murmurs

Severe Mitral Stenosis Lesson

patient thorax when auscultating by stethoscope

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.

Phonocardiogram

Anatomy

Severe Mitral Stenosis

Review the animation and observe the turbulent blood flow from the left atrium into the left ventricle. You can see the severely thickened mitral valve leaflets and the markedly enlarged left atrium. The excursion of the mitral valve leaflets is severely reduced.

Authors and Sources

Authors and Reviewers

Heart sounds by Dr. Jonathan Keroes, MD and David Lieberman, Developer, Virtual Cardiac Patient.
Lung sounds by Diane Wrigley, PA
Respiratory cases: William French
David Lieberman, Audio Engineering
Heart sounds mentorship by >W. Proctor Harvey, MD
Special thanks for the medical mentorship of Dr. Raymond Murphy
Reviewed by Dr. Barbara Erickson, PhD, RN, CCRN.
Last Update: 11/10/2021

Sources

Heart and Lung Sounds Reference Library Diane S. Wrigley
Publisher: PESI
Impact Patient Care: Key Physical Assessment Strategies and the Underlying Pathophysiology
Diane S Wrigley & Rosale Lobo
Practical Clinical Skills: Lung Sounds
PESI Faculty - Diane S Wrigley
Case Profiles in Respiratory Care 3rd Ed, 2019
William A.French
Published by Delmar Cengage
Essential Lung Sounds by William A. French
Published by Cengage Learning, 2011
Understanding Lung Sounds Steven Lehrer, MD
Clinical Heart Disease W Proctor Harvey, MD
Clinical Heart Disease
Laennec Publishing; 1st edition (January 1, 2009)
Heart and Lung Sounds Reference Guide
PracticalClinicalSkills.com