Opening snap and diastolic rumble are classic for which valvular lesion?

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

Answer: (B)

Mitral stenosis. The opening snap comes from the abrupt tensing of thick, stiff mitral valve leaflets as they finally yield to left atrial pressure after S2. This is followed by a low-pitched diastolic rumble from turbulent flow across the narrowed mitral orifice during diastole, best heard at the apex in the left lateral position. This combination is classic for mitral stenosis, often related to rheumatic disease. Other valvular lesions produce different timing and qualities of murmurs (for example, systolic murmurs in aortic or pulmonic stenosis), so they don’t show this distinctive opening snap with a diastolic rumble.