Mitral stenosis heart shape

Mitral stenosis refers to the narrowing of the mucosa at the heart outlet, which will lead to insufficient blood return and increased resistance, and can easily cause numbness and hypoxia of the whole body. It is hoped that patients can undergo surgical treatment in a timely manner. The heart shape of a person with mitral stenosis is generally closed, and the shape is mainly divided into a herringbone shape, so when blood flows back, it will cause the blood flow to slow down.

1. Cardiac auscultation reveals a low-pitched rumbling murmur in the apical area in the middle and late diastole, which is increasing and localized, more obvious in the left lateral decubitus position, and may be accompanied by diastolic tremor. The first heart sound in the apex is hyperactive and clacking. The opening snap (OS) of the mitral valve can be heard in 80% to 85% of patients at the 3rd to 4th intercostal space on the left side of the sternum or on the inner side of the apex. This sound follows the second heart sound, is high-pitched, short and loud, and is obvious during exhalation. It is caused by the vibration of the main valve (anterior leaflet of the mitral valve) of the diaphragmatic valve orifice when it opens. The presence of the slapping first heart sound and the opening snap of the mitral valve highly suggests mitral stenosis and that the valve still has a certain degree of flexibility and activity, which helps in the diagnosis of diaphragmatic mitral stenosis and is of certain significance in deciding the method of surgical treatment.

Due to pulmonary hypertension, the pulmonary valve second heart sound may be hyperactive and split. In severe pulmonary hypertension, a high-pitched, decreasing early and mid-diastolic murmur can be heard between the 2nd and 4th intercostal spaces on the left side of the sternum. It is blowing-like and is transmitted along the left side of the sternum to the tricuspid valve area, and is enhanced during inspiration. This is due to the dilation of the pulmonary artery and its valve ring, resulting in the murmur of relative pulmonary regurgitation (Graham-Settll murmur). Sometimes, an early click sound of pulmonary valve contraction can be heard, which is obvious during exhalation and relieved during inhalation. In patients with severe mitral stenosis, due to pulmonary hypertension, the right ventricle enlarges, causing the tricuspid valve annulus to enlarge, leading to relative tricuspid regurgitation. When the right ventricle contracts, part of the blood flows back through the tricuspid valve orifice to the right atrium, resulting in a holosystolic blowing murmur in the tricuspid valve area, which is transmitted to the apex area and is obvious during inspiration.

2. Other signs: Mitral facies is seen in patients with severe mitral stenosis. Due to reduced cardiac output, the patient's cheeks are purple-red and the lips are slightly cyanotic. Cyanosis is also seen at the extremities. In patients who develop mitral stenosis in childhood, a bulge can be seen in the precordial area, the left nipple moves toward the left upper atrium, and there is a systolic lifting pulsation at the left edge of the sternum. In patients with moderate or severe stenosis, the boundary of the cardiac dullness expands to the left at the third intercostal space on the left edge of the sternum, indicating enlargement of the pulmonary artery and right ventricle. The jugular venous pulsation was palpable, indicating the presence of severe pulmonary hypertension.