Summary:

This patient´s trans-thoracic echocardiogram confirmed the presence of mild mitral stenosis with a relatively pliable valve that will lend itself to balloon valvuloplasty if it is needed in the future.

Click to review auscultation.

Lessons:

1. Even before her echo study this patient was started on Coumadin because of the possibility that her nocturnal palpitation was due to paroxysmal atrial fibrillation, which is a common complication of mitral stenosis.
2. With the help of an Event Recorder a diagnosis of atrial fibrillation was confirmed and appropriate therapy was begun.
3. Her auscultatory findings are typical of mitral stenosis because:
        a. S₁ is loud and snapping.
        b. There is a mitral opening snap (MOS).
        c. The low pitched diastolic rumble gets louder with atrial contraction (presystolic accentuation).
4. Listen again and be sure to notice all three of the above.

 

Case 15 is now finished.