|a u s c u l t a t i o n t u t o r
Opening snap and extra sound algorithm
When stenotic mitral valve leaflets are tethered at their commissures but still flexible (noncalcified), they buckle or bow
outward into the left ventricle when ventricular pressure drops below left atrial pressure, producing a snap. The diastolic
rumble begins a few hundredths of a second later. The snap is best heard at the apex, but may radiate to base and left
sternal border, where it may simulate a widely split S2. This sign is characteristic of rheumatic mitral stenosis.
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