A 32-year-old woman arrives at the clinic complaining of progressive exertional dyspnea and easy fatigability. She immigrated to the United States from India several years ago and claims to have had rheumatic fever as a child. Cardiac auscultation reveals a diastolic high-frequency sound and a rumbling diastolic murmur best heard at the midclavicular line in the left fifth intercostal space. Cardiac catheterization is used to evaluate hemodynamics, and the results are shown below. Which of the following letters best corresponds to the timing of the high-frequency sound heard during cardiac auscultation of this patient?

Question

Quizplus · Accepted Answer

Eductional Objective: Cardiac auscultation reveals a loud first heart sound, an early diastolic opening snap after the second heart sound, and a low-pitched diastolic rumble best heard at the cardiac apex in patients with mitral stenosis. The opening snap is caused by the sudden opening of the mitral valve leaflets at the start of diastole when the left ventricular pressure falls below the left atrial pressure.

A 32-Year-Old Woman Arrives at the Clinic Complaining of Progressive