What are the characteristics of the murmur of mitral stenosis?
The murmur of mitral stenosis is a low-pitched rumbling, best heard with the bell. The murmur is loudest at the apex and there is usually no, or very little, radiation. If the patient is not fibrillating, there is often a presystolic accentuation of the murmur. The murmur is often difficult to hear and may only be detected with the patient lying in the left lateral decubitus position. Even with the patient in this position, it may be necessary to “inch” around the apical area before the murmur is heard. The murmur may be made louder by having the patient exercise (e.g., a hand grip). What are the associated findings in mitral stenosis? The associated findings are: • a loud S1 at the apex; • an opening snap best heard with the diaphragm medial to the apex or along the left sternal border. It occurs in early diastole and may be confused with a widely split S2; • a loud P2 (if there is pulmonary hypertension); • an augmented right ventricular impulse (if there is pulmonary hypertension);
