Mitral stenosis physical examination: Difference between revisions
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{{Mitral stenosis}} | {{Mitral stenosis}} | ||
{{CMG}}; '''Associate Editor(s)-In-Chief:'''{{CZ}} | {{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}} | ||
===Physical examination=== | ===Physical examination=== | ||
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* Left parasternal heave - presence of right ventricular hypertrophy due to pulmonary hypertension | * Left parasternal heave - presence of right ventricular hypertrophy due to pulmonary hypertension | ||
* Tapping apex beat which is not displaced | * Tapping apex beat which is not displaced | ||
[[Category:Valvular heart disease]] | [[Category:Valvular heart disease]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Cardiac surgery]] | |||
[[Category:Surgery]] | |||
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Revision as of 21:17, 9 September 2011
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Mitral Stenosis Microchapters |
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Mitral stenosis physical examination On the Web |
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American Roentgen Ray Society Images of Mitral stenosis physical examination |
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Risk calculators and risk factors for Mitral stenosis physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Physical examination
<youtube v=L5DEqvgS_xs/>
The video with a mid-diastolic rumbling murmur heard after the opening snap. The murmur is best heard at the apical region and is not radiated. Since it is low-pitched it should be picked up by the bell of the stethoscope. Rolling the patient towards left, as well as isometric exercise will accentuate the murmur
<youtube v=E0fDFsmVQfY/> An opening snap which is a high pitched additional sound may be heard after the A2 (aortic) component of the second heart sound (S2), which correlates to the forceful opening of the mitral valve.Initially, an OS is heard because there is an increased gradient between the LA and LV and S1 is loud. As the valve calcifies and LA pressure increases, S1 becomes softer and the OS moves closer to S2.
Murmur
The mitral valve opens when the pressure in the left atrium is greater than the pressure in the left ventricle. This happens in ventricular diastole (after closure of the aortic valve), when the pressure in the ventricle precipitously drops. In individuals with mitral stenosis, the pressure in the left atrium correlates with the severity of the mitral stenosis. As the severity of the mitral stenosis increases, the pressure in the left atrium increases, and the mitral valve opens earlier in ventricular diastole. An opening snap which is a high pitched additional sound may be heard after the A2 (aortic) component of the second heart sound (S2), which correlates to the forceful opening of the mitral valve. The mitral valve opens when the pressure in the left atrium is greater than the pressure in the left ventricle. This happens in ventricular diastole (after closure of the aortic valve), when the pressure in the ventricle precipitously drops. In individuals with mitral stenosis, the pressure in the left atrium correlates with the severity of the mitral stenosis. As the severity of the mitral stenosis increases, the pressure in the left atrium increases, and the mitral valve opens earlier in ventricular diastole. When PHTN develops increased P2, pulmonary ejection sounds, murmurs of PI (Graham Steel), TR and right sided congestive heart failure (RVS3) can be heard. The diastolic murmur does not correlate with tee severity of MS but generally occurs throughout diastole in sever cases. Those in NSR (normal sinus rhythm) will have “presystolic accentuation” of the murmur due to atrial contraction.
Heart: The first heart sound is unusually loud and may be palpable due to the increased force of the closing of the mitral valve.
If pulmonary hypertension secondary to mitral stenosis is severe, the P2 (pulmonic) component of the second heart sound (S2) will become loud.
Peripheral signs include:
- Malar flush - pulmonary hypertension is prominent in patients with mitral stenosis
- Ankle/sacral edema (oedema) when there is right heart failure
- Atrial fibrillation - irregular pulse and loss of 'a' wave in jugular venous pressure
- Left parasternal heave - presence of right ventricular hypertrophy due to pulmonary hypertension
- Tapping apex beat which is not displaced