A crescendo presystolic murmur in patients with mitral stenosis and atrial fibrillation is postulated to be caused by progressive narrowing of the mitral orifice during continued atrioventricular flow.
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Supports postulated mechanism of crescendo murmur in mitral stenosis with AF; single case leaves clinical translation open.
A crescendo presystolic murmur was recorded in four patients with mitral stenosis and atrial fibrillation. Hemodynamic and cineangiographic data support the contention that this crescendo murmur is caused by the closing of the mitral valve in the presence of a persistent end-diastolic pressure gradient between the left atrium and ventricle. We postulate that the progressive narrowing of the mitral orifice in the face of continued atrioventricular flow causes an increase in velocity of flow across the valve leaflets.
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Criley et al. (1971) studied this question.
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