DrVirgo
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In a patient with Rheumatic fever: a loud S1, opening snap, mid diastolic rumble heard at the apex is most consistent with:
A. Mitral Stenosis
B. Mitral Insufficiency
C. Aortic Stenosis
D. Aortic Insuffienency
Please explain the loud S1 and what it means.
Thanks.
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| Kamsi
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A
Mitral stenosis
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| DrVirgo
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Thats right,
WHY the loud S1 though.
Stenosis murmurs happen when the valves are opening. (stenotic valve is hard to open), and Mitral valve is opening before diastole (S2). So shouldn't it present with a loud S2?
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| CocaCola
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a. mitral stenosis
loud S1 - closure of a stenotic valve
diaslotic rumble - filling through the stenotic valve
opening snap - opening of the stenotic valve
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| DrVirgo
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Thanks, that makes sense.
Could Aortic Stenosis cause a loud S1 as well (when the Stenotic valve opens before systole)?
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| CocaCola
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not really because if you think about the mechanics of the heart a stenotic aortic valve will not open until enough force is exerted upon it to overcome the stenosis...
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| donjuan
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s1 closure of mitral and tricupid valve
s2 closure or aortic and pul valve
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| DrVirgo
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Right. When the LV pressure becomes more than the Aortic pressure there will be an ejection click during systole and then a crescendo-decrescendo murmur.
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| okno
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a 
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| arlete
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It's the opposite for aortic stenosis: the worse the stenosis, the quieter the S2. (I just learned with Asher in step 3 ER DVD). Because the valve doesn't open a lot, doesn't make a loud sound when it closes.
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| doyoudig
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S1 closure of Mitral and Tricuspid -- so a loud S1 is b/c stenotic valve is hard to close and makes a loud noise
opening snap after S2 -- means once Aorta n Pulm vavle close (i.e S2 sound has a A2 n P 2 component) the Mitral n tricuspid vavle should open but since there is stenosis its difficult requiring high pressure n loud sound to open
yes arlete, AS -- usually present w/ a single S2, absent S2 or paradoxical S2
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| drduck
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will tell u in simple words..........
consider u in a room i me standing outside trying to lock u inside the room.
u not ready to let me do that....
what do i do.....i try pulling the door.....and u also pull to ur side......
but buddy......consider me having stronger muscles than u......u try try and try unless i FORCEFULLY close the door....and u in agony suddenly LEAVE the door.....what happens then......the door bangs ....producing loud sound.....this can be S1
same way....large amount of blood in atrial systole is pushed nto the empty ventricle...with huge force....but the mitral valve is too small or stenosed...so it opens.......with a loud sound.......but this is not S1.....as valve opening do not produce sound...but we had a sound here and we call it as OPENING SNAP..
after the opening snap....large amount of blood gushes through the stenosed mitral valve and...as opening is delayed and opening is small...it takes longer than normal time for this valve to close........
and the valve leaflets which were forced(stretched) to open up by the coming blood, closes suddenly with a big RECOIL.....resulting in a loud S1.
this was the concept......u will never forget.....i hope
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| arlete
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Very nice, drduck.
Thank you, too, doyoudig.
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| drduck
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| hgheith
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drduck, that was very nice! Thank you, It really did help and I don't think I can forget it now!
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