Auscultatory features of mitral stenosis

Mitral stenosis is a relatively special heart disease. Because our mitral valve is located in a tissue on the ventricle side of our human body, we can generally check the condition of mitral stenosis through some methods. Mitral stenosis has certain characteristics when auscultated, but many people do not know its specific characteristics, or have never understood it. So what are the characteristics of mitral stenosis when auscultated?

Mitral stenosis is the most common rheumatic heart disease. When mitral stenosis occurs to a moderate degree, a series of symptoms will appear. The apex beat is normal, diastolic thrill can be felt in the apex area, the heart is enlarged, and abnormal heart sounds occur during auscultation.

This article summarizes the auscultatory characteristics of how to identify mitral stenosis in rheumatic heart disease, which is helpful for the diagnosis of mitral stenosis.

Due to the presence of mitral stenosis, diastolic blood flows from the left atrium through the narrow mitral valve to the left ventricle, forming a blood flow vortex and producing a low-pitched thunderous (rumbling or drum-like) murmur. The murmur begins in the middle or middle to late diastole, strengthens in the late stage, and continues until the first heart sound of the next hyperactive heartbeat, presenting as an ascending murmur. Diastolic murmur is another important sign of this disease.

Due to the presence of mitral stenosis, the first heart sound is hyperactive, loud, crisp, short and rapt. The snap sound is a characteristic sign of mitral stenosis. Its presence is of great significance for estimating the degree of mitral stenosis, understanding the valve condition, and selecting indications for cardiac surgery.

In severe mitral stenosis, an early diastolic murmur can be heard in the pulmonary valve area, which is called "Schmidt's murmur".

In late-stage mitral stenosis, the first heart sound may be weakened due to the hardening of the valve, which loses its elasticity and vibration force.

The murmur was directed toward the left axilla.

When the murmur is more localized, it is often heard in the apex or its inner side, especially in the left lateral decubitus position. Sometimes a soft mid-diastolic low-pitched murmur can be intensified by holding the breath at the end of exhalation or by speeding up the heartbeat after exercise, and can only be heard in the left lateral decubitus position.

In typical mitral stenosis, there is often a diastolic thrill (on palpation) and a loud 1st heart sound and opening snap.