Rheumatic Heart Disease Mitral Stenosis: Key Physical Signs To Recognize

Rheumatic heart disease leading to mitral stenosis presents distinct clinical signs that are crucial for early detection. While general cardiac symptoms like palpitations and shortness of breath are common, specific physical findings help differentiate this condition from other heart ailments.

Heart Murmur: A Defining Characteristic

The most telling sign of isolated mitral stenosis is a diastolic murmur best heard at the cardiac apex. This low-pitched rumbling sound occurs when blood struggles to pass through the narrowed mitral valve opening from the left atrium to the left ventricle. Physicians typically detect this murmur using the bell of the stethoscope while the patient is in the left lateral decubitus position.

Understanding Hemodynamic Changes

As the valve area decreases below 2 cm², significant hemodynamic changes occur. The left atrium must work harder to push blood through the restricted opening, causing progressive pressure elevation in this chamber. This increased pressure creates a cascade effect through the pulmonary circulation system.

Pulmonary Circulation Impact

Elevated left atrial pressure translates to increased pulmonary venous pressure, which subsequently raises pulmonary artery pressure. This progressive pressure increase follows a specific pathway: from the left atrium → pulmonary veins → pulmonary capillaries → pulmonary arteries.

Clinical Manifestations of Pulmonary Hypertension

Chronic pressure overload in the pulmonary circulation leads to characteristic physical findings. The most notable is an accentuated pulmonic component of the second heart sound (P2), best heard at the left second intercostal space. This loud, palpable sound indicates significant pulmonary hypertension, typically developing when pulmonary artery pressure exceeds 25 mmHg.

Progressive Cardiovascular Changes

As the condition progresses, right heart strain becomes evident through physical examination findings. These may include a palpable right ventricular impulse and signs of right-sided heart failure such as jugular venous distention and peripheral edema. However, these later manifestations typically appear after years of untreated disease progression.