All are seen in chronic MS except-
The first hea sound (S 1 ) is usually accentuated and slightly delayed. The pulmonic component of the second hea sound (P 2 ) also is often accentuated, and the two components of the second hea sound (S 2 ) are closely split. The opening snap (OS) of the mitral valve is most readily audible in expiration at, or just medial to, the cardiac apex. The time interval between A 2 and OS varies inversely with the severity of the MS. The OS is followed by a low-pitched, rumbling, diastolic murmur, heard best at the apex with the patient in the left lateral recumbent position In patients with sinus rhythm, the murmur often reappears or becomes louder during atrial systole (presystolic accentuation). Hepatomegaly, ankle edema, ascites, and pleural effusion, paicularly in the right pleural cavity, may occur in patients with MS and RV failure. ( Harrison&;s principle of internal medicine,18th edition,pg no. 1930)
Mid diastolic murmur
Opening snap
S3
Loud S1
C.V.S