Thursday 6th September 1990   Morning surgery 10.20

Dr Lewis picked up a new patient with mitral stenosis today. My Dad thought that it was a brilliant diagnosis.
“In the first place, Dennis,” he said, “we hardly ever see mitral stenosis these days and, secondly, the murmur is notoriously difficult to hear. I missed a case in finals. I would have failed if I had not done so well with the Parkinson’s patient and that was because my grandfather had Parkinson’s disease and insisted on telling me all about it every time I visited. If only my grandmother had mitral stenosis; I could have had a distinction!”

The mitral valve is one of the most important valves in the heart. In mitral stenosis, it is damaged and does not open properly so the heart cannot pump as efficiently as it should.

Dr Lewis described the sound of mitral stenosis so well that I was almost sure that I could hear it myself.
“High pressure makes the stiffened valve leaflets open with a snap, Dennis. Then, as the blood gushes through and tumbles down into the apex of the left ventricle, you will hear a low, rumbling sound. That’s the murmur. After the murmur, the valve may shut with another snap.”

Dr Lewis had positioned my stethoscope very precisely on Mr Gilroy’s chest. She looked at me as I listened.
“Can you hear it, Dennis?”
I nodded as convincingly as I could.


A brilliant diagnosis!
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