Auscultation of an individual with mitral stenosis reveals an opening snap after the S2 heart sounds, which is caused by the forceful opening of the mitral valve. This is followed by a diastolic murmur.
After the opening snap, there is a late diastolic rumbling murmur that does not radiate. The murmur occurs in diastole because the stenotic valve impedes the filling of the left ventricle during diastole.
The murmur is typically enhanced by expiration due to increase in venous return from the pulmonary veins to the left heart.
The murmur is low-pitched and best heard with the bell of the stethoscope. The duration of the murmur increases with worsening stenosis.
As the stenosis worsens, there is an increase in the left atrial pressures due to an increase in the pressure required to push blood through the stenotic valve. The constant pressure overload of the left atrium can cause dilation, which can compress the esophagus. Individuals with atrial dilation are also more prone to atrial fibrillation.
Almost all cases of mitral stenosis are due to heart disease secondary to recurrent attacks of rheumatic features. Rheumatic fever is an immunologically mediated inflammatory disease that typically develops two to three weeks after an episode of group A streptococcal pharyngitis.
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