Which heart disease presents with an opening snap in early diastole and a soft diastolic rumble heard at the apex in the left lateral decubitus position?

Which heart disease presents with an opening snap in early diastole and a soft diastolic rumble heard at the apex in the left lateral decubitus position?

• A. Aortic regurgitation
• B. Mitral stenosis
• C. Tricuspid stenosis
• D. Mitral regurgitation

Answer: (B)

This presentation reflects classic mitral stenosis. The opening snap occurs in early diastole when the stiff, thickened mitral valve leaflets snap open after the aortic valve closes. The resulting low-pitched, diastolic rumble is best heard at the apex with the patient in the left lateral decubitus position, and the murmur is relatively soft. The left lateral position brings the apex—and thus the mitral area—closer to the chest wall, making the diastolic rumble more audible. Other causes don’t fit as neatly: aortic regurgitation produces a high-pitched early diastolic murmur heard along the left sternal border, not an opening snap or an apical rumble. Mitral regurgitation is a systolic murmur heard at the apex radiating to the axilla. Tricuspid stenosis can cause a diastolic rumble at the left lower sternal border, but the classic opening snap and apex location in left lateral decubitus are characteristic of mitral stenosis.

This presentation reflects classic mitral stenosis. The opening snap occurs in early diastole when the stiff, thickened mitral valve leaflets snap open after the aortic valve closes. The resulting low-pitched, diastolic rumble is best heard at the apex with the patient in the left lateral decubitus position, and the murmur is relatively soft. The left lateral position brings the apex—and thus the mitral area—closer to the chest wall, making the diastolic rumble more audible.

Other causes don’t fit as neatly: aortic regurgitation produces a high-pitched early diastolic murmur heard along the left sternal border, not an opening snap or an apical rumble. Mitral regurgitation is a systolic murmur heard at the apex radiating to the axilla. Tricuspid stenosis can cause a diastolic rumble at the left lower sternal border, but the classic opening snap and apex location in left lateral decubitus are characteristic of mitral stenosis.