Mitral Stenosis

Mitral stenosis is characterized by obstruction to left ventricular inflow at the level of mitral valve due to structural abnormality of the mitral valve apparatus. The most common cause of mitral stenosis is rheumatic fever.

The normal mitral valve orifice area is approximately 4-6 cm2.Patients will not experience valve-related symptoms until the valve area is 2-2.5 cm2 or less.Severe mitral stenosis occurs with a valve area of less than 1 cm2.

Presence of mitral facies indicate chronic severe mitral stenosis leading to reduced cardiac output and vasoconstriction.The apical impulse may be laterally displaced or not palpable, especially in cases of severe mitral stenosis. This can be explained by decreased left ventricular filling.tapping type of apex beat is seen.

The auscultatory findings characteristic of mitral stenosis are a loud first heart sound, an opening snap, and a diastolic rumble.The intensity of the first heart sound diminishes as the valve becomes more fibrotic, calcified, and thickened.

The diastolic murmur of mitral stenosis is of low pitch, rumbling in character, and best heard at the apex with the patient in the left lateral position.