Rheumatic Heart Disease Mitral Stenosis: Key Physical Signs and Symptoms

Heart-related symptoms often include palpitations and shortness of breath. However, in the case of isolated mitral valve stenosis, one of the most significant physical signs is a diastolic murmur heard at the apex of the heart. This occurs because the narrowing of the mitral valve restricts blood flow from the left atrium to the left ventricle, leading to increased pressure in the left atrium.

Impact on the Left Atrium and Pulmonary Circulation

As the pressure in the left atrium rises due to the obstruction, it affects the pulmonary circulation. Blood returning from the lungs faces increased resistance, which results in elevated pulmonary venous pressure. This pressure buildup can lead to pulmonary congestion and, over time, may contribute to the development of pulmonary hypertension.

Development of Pulmonary Hypertension

As pulmonary hypertension progresses, it causes noticeable clinical signs. One such sign is an increased intensity of the second heart sound at the pulmonary valve, known as a loud P2. This sound is best heard at the second intercostal space along the left sternal border and is often described as a sharp, forceful sound. This phenomenon, medically referred to as pulmonary component of the second heart sound (P2) accentuation, is a key indicator of elevated pulmonary artery pressure.

Clinical Relevance of Cardiac Auscultation

Proper auscultation and identification of these heart sounds are essential in diagnosing mitral stenosis and monitoring its progression. Detecting a diastolic rumble at the apex combined with a prominent P2 sound can help clinicians assess the severity of the condition and guide further diagnostic and treatment strategies.