Explanation

Mitral stenosis is defined as the reduced ability of the blood to move from the left atrium to the left ventricle in diastole. It is mostly caused by dysfunction of the mitral valve, which lacks the ability to open its leaflets in diastole. Mitral valve stenosis is predominantly caused by rheumatic carditis and is more prevalent in women. The main symptoms of mitral stenosis are slowly progressive dyspnea and fatigue. Most auscultatory signs are missed if not performed in the left lateral decubitus position. Typically, the first heart sound (S1) is accentuated. A low-pitched diastolic rumble heard with the bell of the stethoscope over the apex is also present. The high-pitched opening snap is caused by the abrupt stopping of the domed mitral valve into the left ventricle (also appreciated in most patients midway between the left sternal border and the apex). A shorter A2-opening snap (A2-OS) distance indicates a more severe mitral stenosis. Signs of pulmonary hypertension, such as a loud P2 and right ventricular hypertrophy, can also be present as the stenosis becomes more severe.

Physical signs of severe aortic regurgitation (A) include a rapid, quick arterial pulse; a wide pulse pressure; an early high-pitched, blowing diastolic murmur heard best over the left sternal border; an S3 gallop; and a low-pitched diastolic murmur at the apex (Austin-Flint murmur). The typical physical signs of severe aortic valve stenosis (B) are diminished carotid pulses (delayed and weak), a sustained apical impulse, a single second heart sound, an S4 gallop, and a midsystolic crescendo-decrescendo murmur with late peaking best heard at the base of the heart. In mitral regurgitation (C), patients will display a systolic murmur, most often holosystolic, high-pitched, and present at the apex with radiation to the axilla, left scapula, middle back, or left sternal border, depending on the direction of the regurgitant jet.