Question about Mitral Valve Stenosis

UM Review RN, ASN, RN · Feb 16, 2005

Did you listen with just your ear?

No, seriously!

Here's an excerpt from the AHA website that explains the grading of murmurs. They're described as 1-6 grade of loudness:

http://www.americanheart.org/presenter.jhtml?identifier=4571

Heart Murmurs

What causes heart murmurs?

Heart murmurs are most often caused by defective heart valves. A stenotic (sten-OT'ik) heart valve has a smaller-than-normal opening and can't open completely. A valve may also be unable to close completely. This leads to regurgitation, which is blood leaking backward through the valve when it should be closed.

Murmurs also can be caused by conditions such as pregnancy, fever, thyrotoxicosis (thi"ro-toks"ih-KO'sis) (a diseased condition resulting from an overactive thyroid gland) or anemia.

A diastolic (di"as-TOL'ik) murmur occurs when the heart muscle relaxes between beats. A systolic (sis-TOL'ik) murmur occurs when the heart muscle contracts. Systolic murmurs are graded by intensity (loudness) from one to six. A grade 1/6 is very faint, heard only with a special effort. A grade 6/6 is extremely loud. It's heard with a stethoscope slightly removed from the chest.

jnette, ASN, EMT-I · Feb 16, 2005

Thanx for the site...

No, not audible with the bare ear ... now THAT would be scary ! :chuckle

And while I don't hear a regurgitation per say, I DO hear a most audible S3 gallop. Just with the diaphragm.

Will check out the site.. thank you ! :)

ekalbab · Feb 23, 2005

OK, you admirable cardiac nurses.... I have a question for you. :)
It is said that the S3 gallop sound is best heard with the bell of the stethescope at the apex area of the heart. Is there any significance if you hear this gallop VERY audibly with just the diaphragm ?
A stronger sound could be an indicator of a worse condition but is not used alone diagnosticly.

candyndel · Mar 2, 2005

An S3 is a gallop, its not really a murmur at all. Its an extra heart sound and yes, u hear it with the diaphragm (i dont even have a bell!). It sounds like the S2 is almost stuttering (is how i explain it). You have 3 heart sounds instead of 2. Its a ventricular gallop and is caused by ventricular stiffness

(noncompliance) as with HF. S4 sounds like the S1 is stuttering. Thats an atrial gallop. Listen to your pts with HF, they almost all have either/or!

Murmurs are pretty much heard within the S1 or S2 and they basically make the S1 or S2 sound not as crisp (almost dragging, if u will). Instead of Lub-Dub, a systolic mumur sounds to me like Luuuuuuub-Dub. And a diastolic murmur sounds like Lub- Duuuuuuuuub. Most pts on HD have murmurs. Listen to them,you can tell that the S1 or S2 dont sound as crisp. Then you can tell if your pt has a systolic or diastolic murmur! Does that make sense to only me? I hope this helps...

QUOTE=jnette]OK, you admirable cardiac nurses.... I have a question for you. :)

It is said that the S3 gallop sound is best heard with the bell of the stethescope at the apex area of the heart. Is there any significance if you hear this gallop VERY audibly with just the diaphragm ?

Thanx !

PHTLS · Mar 6, 2005

An S3 is basically the heart filling up with blood, right (been a while since I read the cardiac section of my old med surg book)? S2 are the Valves closing, right? If you turn the patient to his/her left side, you should be able to hear the heart better, right?

Damn, let me correct myself (flipping through med surg book):

S1 mitral valves and tricuspid valves closing and occurs right after QRS.

S2 are the pulmonic and aortic valves closing and has a higher pitch sound to it. It's best heard at the base of the heart.

candyndel · Mar 7, 2005

right... and stenosis affects the blood moving through the valve (when the valve is open). the mitral valve opens in diastole, so MS is heard at the beginning of diastole (S2).

MR would be heard in systole (when the mitral valve closes).

An S3 is basically the heart filling up with blood, right (been a while since I read the cardiac section of my old med surg book)? S2 are the Valves closing, right? If you turn the patient to his/her left side, you should be able to hear the heart better, right?
Damn, let me correct myself (flipping through med surg book):
S1 mitral valves and tricuspid valves closing and occurs right after QRS.
S2 are the pulmonic and aortic valves closing and has a higher pitch sound to it. It's best heard at the base of the heart.