Abstract
32-year-old man with a history of rheumatic fever as a child had pleuritic chest discomfort, hemoptysis, and [ill]ressive dyspnea on exertion. The first heart sound was [ill]ntuated, as was P<sub>2</sub>. There was minimal splitting of the [ill]nd heart sound. At the apex, an opening sound was followed by a soft, low-pitch middiastolic rumble. A third heart sound was not present. The ECG showed sinus tachycardia, a normal QRS axis, and right atrial abnormality. A pulmonary ventilation-perfusion scan was normal. A representative portion of the patient's M-mode echocardiogram of the mitral valve is shown below (Fig 1). What is your diagnosis? What does the echo labeled X represent? What two additional applications of cardiac ultrasound could be employed to help quantify the degree of disease? Diagnosis—<i>Mitral Stenosis</i> The M-mode echocardiogram shown in Fig 1 demonstrates characteristic findings of mitral stenosis. The anterior mitral leaflet (AML) is thickened and demonstrates a flattened
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