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Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. [1] It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm 2 during diastole. Any decrease in area below 2 cm 2 causes mitral stenosis. Early diagnosis of mitral stenosis ...
The other type of heart murmur is due to a structural defect in the heart itself. [ 1 ] [ 5 ] Defects may be due to narrowing of one or more valves (stenosis), backflow of blood , through a leaky valve (regurgitation), or the presence of abnormal passages through which blood flows in or near the heart.
The mitral valve in cases of mitral stenosis may open with an opening snap [1] [2] on the beginning of diastole. Patients with mitral valve prolapse may have a mid-systolic click along with a murmur, referred to as apical late systolic murmur. [3] Early systolic clicks may also be present in some patients. [4]
A presystolic murmur, also called presystolic accentuation, is a type of diastolic heart murmur typically associated with the opening snap in mitral valve stenosis.It is heard following the middiastolic rumble of the stenotic valve, [1] during the diastasis phase, making it a "late diastolic" murmur.
Mitral valve prolapse: The click and the murmur of mitral valve prolapse are delayed because left atrial volume also increases due to mitral regurgitation along with increased left ventricular volume. [5] Murmurs that are due to forward flowing of blood such as aortic stenosis, and hypertrophic cardiomyopathy decrease in intensity. [4]
Mitral stenosis: This murmur has a rumbling character and is best heard with the bell of the stethoscope in the left ventricular impulse area with the patient in the lateral decubitus position. It usually starts with an opening snap. In general, the shorter the duration (S2 to Opening Snap), the more severe the mitral stenosis.
Abnormal murmurs can be caused by stenosis restricting the opening of a heart valve, resulting in turbulence as blood flows through it. Abnormal murmurs may also occur with valvular insufficiency ( regurgitation ), which allows backflow of blood when the incompetent valve closes with only partial effectiveness.
The murmur is heard due to a high velocity flow back across the pulmonary valve; this is usually a consequence of pulmonary hypertension secondary to mitral valve stenosis. The Graham Steell murmur is often heard in patients with chronic cor pulmonale (pulmonary heart disease) as a result of chronic obstructive pulmonary disease. [citation needed]