Following are the physical
examination signs in mitral stenosis
1.
Normal or low volume pulse : Atrial fibrillation may be present.
2.
Normal to low pulse pressure
3.
Normal or raised jugular venous pressure
4.
Tapping apex beat present
5.
S1 palpable
6.
Apical diastolic thrill
7.
Loud S1
8.
Loud P2 (if PAH – pulmonary artery hypertension is present)
9.
Opening snap present
10.
Rough and rumbling low pitched middiastolic murmur with
presystolic accentuation heard in mitral area.
The cardinal features
are
1.
Tapping apex
2.
Diastolic thrill
3.
Loud S1
4.
Opening snap
5.
MDM with presystolic accentuation
Describe pulse in atrial fibrillation
1.
Usually pulse normal
2.
Low volume in severe MS
3.
Irregularly irregular in AF
4.
Peripheral pulses can be absent due to embolism as a result of
atrial fibrillation.
Why the apex is tapping in mitral stenosis
It is due to loud
palpable S1
Loud S1 indicate pliable anterior mitral leaflet usually apex beat is in normal
position. If apex goes outward indicate RVH , it is downward and
outward in LVH then think of other causes such as MR, AR, AS,
systemic HTN. Diffuse apex beat is present in RVH.
