Diastolic Murmurs

Moderate Mitral Stenosis Lesson #689

patient thorax when auscultating by stethoscope

The patient was supine left side down during auscultation.

Description

This is an example of moderate mitral stenosis. The first heart sound is increased in intensity. The second heart sound is normal and unsplit. Systole is silent. There is an opening snap 75 milliseconds into diastole. As mitral stenosis becomes more severe, this opening snap will occur earlier in diastole.

A diamond-shaped, low-frequency murmur follows the opening snap. There is a second murmur in late diastole due to contraction of the left atrium.

Auscultate using the bell of the stethoscope.

Mitral stenosis can be caused by rheumatic heart disease, and this causes a thickening of the mitral valve leaflets. In the cardiac animation, observe turbulent blood flow from the left atrium into the left ventricle. Take note of the moderately thickened mitral valve leaflets and the moderately enlarged left atrium. The excursion of the mitral valve leaflets is moderately decreased.

Phonocardiogram

Anatomy

Moderate Mitral Stenosis

In this animation observe the turbulent blood flow from the left atrium into the left ventricle. You can see the moderately thickened mitral valve leaflets and the moderately enlarged left atrium. The excursion of the mitral valve leaflets is moderately decreased.

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
Essential Lung Sounds Diane S. Wrigley, PA-C
Published by MedEdu LLC
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