This is an example of severe mitral stenosis combined with mild mitral regurgitation in a patient with rheumatic heart disease.
The first heart sound is slightly louder than normal.
The second heart sound is unsplit.
There is an opening snap fifty milliseconds after the second heart sound.
There is a low frequency murmur filling all of diastole. The first two-thirds of the murmur is diamond shaped and the last third is a crescendo.
There is a rectangular medium frequency murmur which fills the first half of systole.
In the anatomy tab you can see an enlarged left atrium and thickened mitral valve leaflets which barely moved. The turbulent blood flow represents the systolic and diastolic murmurs.