A 26-year-old pregnant woman has been detected to have a diastolic murmur in mitral area. Echocardiography reveals mitral valve orifice to be 0.8 cm2. The cause of her murmur is
**Core Concept**
Mitral stenosis is characterized by the narrowing of the mitral valve orifice, impeding blood flow from the left atrium to the left ventricle. This condition often results from rheumatic heart disease, which causes scarring and calcification of the valve leaflets.
**Why the Correct Answer is Right**
The patient's echocardiography findings of a mitral valve orifice of 0.8 cm² are diagnostic of mitral stenosis. This reduced valve area impairs left atrial emptying, leading to increased left atrial pressure and subsequent pulmonary congestion. The diastolic murmur heard in the mitral area is a characteristic feature of mitral stenosis, resulting from the turbulent blood flow through the narrowed valve orifice. The murmur's timing corresponds to the diastolic phase, when blood flows from the left atrium to the left ventricle.
**Why Each Wrong Option is Incorrect**
**Option A:** Mitral regurgitation is characterized by a systolic murmur due to blood leaking back from the left ventricle into the left atrium during systole, which is not consistent with the patient's presentation.
**Option B:** Mitral valve prolapse is a condition where the mitral valve leaflets bulge back into the left atrium during systole, typically producing a mid-systolic click and/or a late-systolic murmur, not a diastolic murmur.
**Option C:** Aortic stenosis would present with a systolic murmur due to turbulent blood flow through the narrowed aortic valve orifice, not a diastolic murmur in the mitral area.
**Clinical Pearl / High-Yield Fact**
The "hole-in-the-heart" sign, where the diastolic murmur of mitral stenosis is interrupted by an opening snap, is a classic clinical finding that can aid in diagnosis. This opening snap corresponds to the sudden opening of the stenotic mitral valve.
**Correct Answer: B. Mitral valve prolapse is a condition where the mitral valve leaflets bulge back into the left atrium during systole, typically producing a mid-systolic click and/or a late-systolic murmur, not a diastolic murmur.