Mitral Stenosis - Moderate | Lessons with Audio and Video | #97

This is an example of moderate mitral stenosis which is most commonly due to rheumatic heart disease. The first heart sound is increased in intensity due to moderate thickening of the mitral valve leaflets. 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, the opening snap will occur earlier in diastole. The opening snap is followed by a diamond shaped low frequency murmur. Use the bell of the stethoscope to hear this murmur. There is a second murmur in late diastole due to contraction of the left atrium. In the animation you can see 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.

Auscultation Sounds

Patient Recording

Patient Recording - Half Speed

Position

The patient's position should be supine left side down.

Listening Tips

S1:Increased intensity
Diastole:Opening snap followed by diamond shaped, low-pitched murmur

Waveform (Phonocardiogram)

Observe Cardiac Animation

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

EKG heart rhythm modules: Thomas O'Brien.
EKG monitor simulation developer: Steve Collmann
12 Lead Course: Dr. Michael Mazzini, MD.
Spanish language EKG: Breena R. Taira, MD, MPH
Medical review: Dr. Jonathan Keroes, MD
Heart sounds and mentorship: W. Proctor Harvey, MD
Medical review: Dr. Pedro Azevedo, MD, Cardiology
Last Update: 1/8/2023

Sources

Electrocardiography for Healthcare Professionals, 5th Edition Kathryn Booth and Thomas O'Brien
ISBN10: 1260064778, ISBN13: 9781260064773
McGraw Hill, 2019
Rapid Interpretation of EKG's, Sixth Edition
Dale Dublin
Cover Publishing Company
12 Lead EKG for Nurses: Simple Steps to Interpret Rhythms, Arrhythmias, Blocks, Hypertrophy, Infarcts, & Cardiac Drugs
Aaron Reed
Create Space Independent Publishing
Heart Sounds and Murmurs: A Practical Guide with Audio CD-ROM 3rd Edition
Elsevier-Health Sciences Division
Barbara A. Erickson, PhD, RN, CCRN
Clinical Heart Disease W Proctor Harvey, MD
Clinical Heart Disease
Laennec Publishing; 1st edition (January 1, 2009)
The Virtual Cardiac Patient: A Multimedia Guide to Heart Sounds, Murmurs, EKG Jonathan Keroes, David Lieberman
Publisher: Lippincott Williams & Wilkin)
ISBN-10: 0781784425; ISBN-13: 978-0781784429
Project Semilla, UCLA Emergency Medicine, EKG Training Breena R. Taira, MD, MPH

Return to Reference Guide Index Page

Mitral Stenosis - Moderate | Lessons with Audio and Video | #97