Diastolic murmur of mitral stenosis is best heard at which location and patient position?

• A. Apex with patient standing
• B. Apex with patient in left lateral decubitus position
• C. Base of heart with patient lying supine
• D. Right sternal border with patient sitting upright

Answer: (B)

Mitral stenosis produces a low-pitched diastolic rumble that is best heard at the apex when the patient is in the left lateral decubitus position. This position brings the left atrium and mitral valve closer to the chest wall, amplifying these low-frequency sounds, and the apex (the 5th left intercostal space at the midclavicular line) is the valve’s listening spot. Listening with the bell and sometimes during expiration helps exaggerate the murmur and the typical opening snap. Murmurs heard at the base or along the right sternal border point to other valves, and standing or upright positions tend to reduce the murmur by lowering venous return, whereas the left lateral decubitus position enhances it.