All the following may be seen as severity of mitral stenosis increase except

Ref Harrison 19 th ed pg 1540 general, the duration of this murmur correlates with the severity of the stenosis in patients with preserved CO. In patients with sinus rhythm, the murmur often reappears or becomes louder during atrial systole (presystolic accentuation). Soft, grade I or II/VI systolic murmurs are commonly heard at the apex or along the left sternal border in patients with pure MS and do not necessarily signify the presence of MR. Hepatomegaly, ankle edema, ascites, and pleural effusion, paicularly in the right pleural cavity, may occur in patients with MS and RV failure.