Mitral stenosis from the left sternal border
by Franklin B Saksena, Ranganathan Narasimhan, Sivaciyan Vahe

The Art and Science of Cardiac Physical Examination (With Heart Sounds, Jugular and Precordial Pulsations)

by Narasimhan Ranganathan, Vahe Sivaciyan, Franklin B Saksena
About Video

The audio recording from a patient with known mitral stenosis taken from the left sternal border area. All of the following statements are correct except: (A) The S1 is loud and the rhythm is suggestive of atrial fibrillation, (B) There is an OS audible as confirmed by the suggestion of a faint trill, (C) The S2-OS interval is quite short and suggestive of high left atrial pressure, (D) The findings suggest mixed lesion of significant mitral stenosis and regurgitation. The patient is in atrial fibrillation with a fairly rapid heart rate and short diastoles. The left atrial pressure must be high from a tight mitral stenosis and tachycardia during atrial fibrillation accounting for the short S2-OS interval. (Trill refers to A2_P2_OS combination giving a triple sound effect). There is no need to invoke additional significant mitral regurgitation to explain the findings.

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