Mitral Stenosis Symptoms and Clinical Manifestations

Patients with mitral stenosis often display a distinctive facial appearance known as "mitral facies," characterized by cyanotic redness on both cheeks. This visible sign is commonly associated with chronic heart conditions and can serve as an early indicator for clinicians.

Physical Signs of Right Heart Failure

In more advanced cases, especially when right heart failure develops, several physical symptoms may appear. A palpable lifting impulse can often be felt below the xiphoid process. Other signs include jugular venous distension, a positive hepatojugular reflux test, hepatomegaly, and bilateral lower limb edema. These manifestations reflect the increased pressure in the right side of the heart due to the progression of the disease.

Characteristic Heart Murmurs

Mid-Diastolic Murmur

The hallmark auscultatory finding in mitral stenosis is a low-pitched, rumbling mid-to-late diastolic murmur. This murmur typically has a crescendo pattern and is best heard at the apex of the heart. It becomes more pronounced when the patient lies on their left side and may intensify during physical activity or exertion. The presence of a diastolic thrill often accompanies this murmur, further supporting the diagnosis.

Atrial Fibrillation Influence

When atrial fibrillation coexists with mitral stenosis, the characteristic murmur may become less distinct. This irregular heart rhythm can alter the hemodynamic pattern, making auscultation findings less typical and potentially complicating the diagnostic process.

Pulmonary Hypertension Related Murmur

In cases where pulmonary hypertension develops secondary to mitral stenosis, an early diastolic decrescendo high-pitched sighing murmur can be heard along the left sternal border at the second intercostal space. This finding indicates increased pressure in the pulmonary artery and suggests disease progression.

Right Ventricular Involvement

When right ventricular enlargement occurs, a holosystolic blowing murmur may be detected at the left sternal border between the fourth and fifth intercostal spaces. This murmur typically indicates tricuspid regurgitation secondary to right ventricular dilation and represents significant structural changes in heart anatomy.