A 72-year-old male comes to the MOPD with intermittent symptoms of dyspnea on exeion, palpitations, and cough occasionally productive of blood. On cardiac auscultation, a low-pitched diastolic rumbling murmur is faintly heard toward the apex. The origin of the patient's problem probably relates to

The history and physical exam findings are consistent with mitral stenosis. Dyspnea may be present secondary to pulmonary edema; palpitations are often related to atrial arrhythmias (PACs, PAT, atrial flutter or fibrillation); hemoptysis may occur as a consequence of pulmonary hypeension with rupture of bronchial veins. A diastolic rumbling apical murmur is characteristic. An accentuated first hea sound and opening snap may also be present. The etiology of mitral stenosis is usually rheumatic, rarely congenital. Two thirds of patients afflicted are women.