mitral valve stenosis murmur

• L: Apex,

• T: mid-late D,

• Shape: opening snap + decrescendo (rumble) + pre-S accentuation,

  • shorter interval between S2 and opening snap = worse stenosis

• R: x radiate,

• Grade: 1-4,

• Pitch: low pitch (bell),

• Maneuver: left lateral position, better heard in exhalation

  

Associated finding

• Commonly w. Augmented S1, Fixed, Wide S2
• Assoc. w/ **AF,** Hx of rheumatic fever, RV failure, LA dilation, PH - Pulmonary hypertension