We saw a classic case at the recent Dubai PACES course conducted by IBC
The patient was a young man who looked fit and healthy.
His pulse rate was 80 beats per minute, regular rhythm. His JVP was not elevated, trachea midline. Apex was not displaced and normal in character. The first heart sound was loud. This was the first clue that there could be a valvular lesion and quite correctly the candidates thought that the patient may have mitral stenosis. The second hear sound was of normal intensity, suggesting that the patient had not developed pulmonary hypertension. There was a clear cut opening snap in keeping with mitral stenosis. There was the classic decrescendo mid-diastolic rumble heard just medial to the apex beat and there was pre-systolic accentuation of the murmur indicating vigorous left atrial contraction. The findings were accentuated by turning the patient to the left lateral position and by exercise.
Lungs were clear
Diagnosis
Mitral stenosis
Sinus rhythm
No heart failure or pulmonary hypertension
Most likely as a consequence of rheumatic fever
