# A patient with mitral stenosis shows a loud ______ murmur best heard at the apex with the bell of the stethoscope.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=168398  
> language: ko  
> subject: Diseases of the circulatory system

## 문제

A patient with mitral stenosis shows a loud ______ murmur best heard at the apex with the bell of the stethoscope.

## 보기

1. rumbling **✔ 정답**
2. harsh
3. blowing
4. musical
5. scratching

**정답: 1**

## 해설

A rumbling murmur is characteristic of mitral stenosis and is best heard with the bell of the stethoscope at the cardiac apex. This low-pitched diastolic murmur occurs as blood attempts to flow through the narrowed mitral valve during ventricular filling.

## 임상 시나리오

Mitral Stenosis Murmur Characteristics:
- Low-pitched diastolic murmur
- Best heard at cardiac apex
- Bell of stethoscope required
- Opening snap often precedes murmur
- Increased intensity in left lateral position
- Loudest in presystole with sinus rhythm
- Duration correlates with severity
- Associated findings: loud S1, P2 accentuation
- Causes: rheumatic fever, calcification
- Hemodynamic effects: LA enlargement, pulmonary hypertension
- Symptoms: dyspnea, fatigue, palpitations
- Auscultation technique: patient in left lateral decubitus
- Grade: I-IV/VI intensity scale
- Transmission: limited to apical area
- Differential diagnosis: Austin Flint murmur

## 핵심 개념

- **rumbling** — A low-pitched, vibrating sound similar to distant thunder, typically associated with mitral stenosis
- **harsh** — A rough, grating sound quality often associated with turbulent blood flow through narrowed vessels
- **blowing** — A soft, whooshing sound similar to air moving through a tube, often heard in valvular regurgitation
- **musical** — A high-pitched, melodious sound that has a distinct tonal quality, often heard in certain cardiac conditions
- **scratching** — A rough, friction-like sound typically associated with pericardial friction rub or pleural sounds

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