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Mechanism of diastolic rumble and presystolic murmur in mitral stenosis
Toutouzas, P.
Koidakis, A.
Velimezis, A.
Avgoustakis, D.
The mechanism of the murmurs heard in mitral stenosis was studied in 6i patients by using simultaneous recordings of the mitral valve echocardiogram, phonocardiogram, and apex cardiogram. It was observed that: (a) the diastolic rumble began just after the E point of the echocardiogram, clearly related to the diastolic closure of the valve, and was never recorded during the opening motion of the valve, which in 49 patients was completed (Epoint) 20 to 6o msec after the opening snap; (b) the presystolic murmur was recorded at the time the mitral valve was closing during preisometric contraction of the left ventricle. It is suggested that both murmurs probably originate from impact between increased velocity offorward blood flow and the backward closing motion of the mitral valve. This mechanism explains (i) the frequently noted gap between the opening snap and the onset of the diastolic rumble; (2) the reduction in amplitude or disappearance of the diastolic rumble in calcified mitral stenosis; and (3) the occasional presence of a presystolic murmur in atrial fibrillation.
(EN)
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