Mid-diastolic rumble with presystolic accentuation is most characteristic of which valvular lesion?

Mid-diastolic rumble with presystolic accentuation is most characteristic of which valvular lesion?

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

Answer: (A)

Mid-diastolic rumble with presystolic accentuation is a hallmark of mitral stenosis. The narrowed mitral orifice causes turbulent flow primarily during diastole as blood moves from the left atrium into the left ventricle. This produces a low-pitched, rumbling murmur best heard at the apex in the left lateral decubitus position. The murmur often shows presystolic accentuation because atrial contraction near the end of diastole pushes more blood across the stenotic valve, intensifying the flow just before S1. This pattern distinguishes it from other valvular lesions: aortic stenosis has a systolic ejection murmur, aortic regurgitation has an early diastolic decrescendo murmur, and tricuspid regurgitation is a holosystolic murmur at the left lower sternal border.

Mid-diastolic rumble with presystolic accentuation is a hallmark of mitral stenosis. The narrowed mitral orifice causes turbulent flow primarily during diastole as blood moves from the left atrium into the left ventricle. This produces a low-pitched, rumbling murmur best heard at the apex in the left lateral decubitus position. The murmur often shows presystolic accentuation because atrial contraction near the end of diastole pushes more blood across the stenotic valve, intensifying the flow just before S1.

This pattern distinguishes it from other valvular lesions: aortic stenosis has a systolic ejection murmur, aortic regurgitation has an early diastolic decrescendo murmur, and tricuspid regurgitation is a holosystolic murmur at the left lower sternal border.