Finally, we shall listen at the apex and now we shall use the bell of the stethoscope because we want to listen particularly for low frequency heart sounds. Again, we'll time by using the carotid vessel. [Cut-away]
When listening for low frequency acoustic events at the apex, I heard none, neither heart sounds nor murmurs. This may help us in our differential diagnosis of the cause of our patient's pulmonary hypertension.
Discussion
The absence of an opening snap and a low frequency diastolic rumbling murmur at the apex makes mitral stenosis unlikely as the cause of our patient's pulmonary hypertension. However, in patients with low cardiac output and decreased flow, this murmur is sometimes difficult to detect.