The Crescendo Presystolic Murmur of Mitral Stenosis with Atrial Fibrillation

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Abstract
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.