Clinical picture:

1.Dyspnea on exertion.

2.Orthopnea & paroxysmal nocturnal dyspnea.

3.Poor growth and development.

4.Tachycardia and atrial fibrillation.

5.Congestive heart failure may be present.

Inspection, palpation and percussion:

1)against the background of pale skin is observed

Mitral blush and acrocyanosis (cyanosis of the fingertips, nose, ear shells):

2)pulsation of the pulmonary artery in II intercostal space to the left of the sternum:

3)diffuse cardiac impulse (hypertrophy

4)expansion of the borders of the heart upward (L1) and to the right (RH):

5)diastolic tremor at the apex ("Cat purr").

Butterfly with metral stenosis

Auscultation:

1.Loud S1- as loud as S2 in aortic area.

2.A2 to OS interval inversely proportional to

severity.

3.Diastolic rumble: length proportional to severity.

4.In severe MS with low flow- S1, OS & rumble may be inaudible.

Mitral stenosis murmur:

1.First heartS1 sound (S1) is accentuated and snapping.

2.Opening snap (OS) after aortic valve closure.

3.Low pitch diastolic rumble at the apex.

4.Pre-systolic accentuation (esp. if in sinus rhythm).

Chest X-Ray (CXR):

1.Large LA.

2.Pulm venous congestion.

3.RV dilatation, interstitial/alveolar edema.

CXR:

Mitral Valve Stenosis:

Mitral Valve Stenosis:

EKG:

1. A Fib.

2.

3. LAE, RVH.