Diastolic Murmurs

Mitral Stenosis - Severe

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This is an example of severe mitral stenosis which is most commonly due to rheumatic heart disease.

The first heart sound is decreased in intensity due to severe thickening of the mitral valve leaflets.

The second heart sound is normal and unsplit.

Systole is silent.

There is an opening snap 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 animation you can see 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.

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The recommended auscultation position for the stethoscope is the Mitral position. For this sound, use stethoscope's Bell.

maneuver

The recommended patient position is Supine left side down

Phonocardiogram

This waveform plots sound amplitude on the vertical axis against time on the horizontal axis.

Heart Animation

Lessons

Aortic Regurgitation - Mild
Pulmonic Regurgitation - Mild
Mitral Stenosis - Mild
Mitral Stenosis - Moderate
Mitral Stenosis - Severe
Tricuspid Stenosis - Moderate

Practice Drill

Listening Tips
A synopsis of important sound features and timing for this abnormality.
S1: Decreased intensity.
Diastole: Opening snap then diamond shaped low pitch murmur.

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CourseID	27
CourseCaseOrder	5
ID	88