A case of severe mitral stenosis is associated with all of the following features, EXCEPT:
Severe mitral stenosis occurs with a valve area of less than 1 cm2 (The normal mitral valve orifice area is approximately 4-6 cm2). As the valve progressively narrows, the resting diastolic mitral valve gradient, and hence left atrial pressure, increases. This leads to transudation of fluid into the lung interstitium and dyspnea at rest or with minimal exeion. Hemoptysis may occur if the bronchial veins rupture and left atrial dilatation increases the risk for atrial fibrillation and subsequent thromboembolism. The length of the murmur, as opposed to the intensity, is used as a nonspecific guide to stenosis severity. Pulsatile liver may be present.
Pulsatile liver
Atrial fibrillation
Opening snap delayed from S2
Increase in the length of murmur