All of the following hea sounds are heard in chronic mitral stenosis except?

Ans. B. Third hea sound. Clinical Findings in Mitral Stenosis Upon auscultation of an individual with mitral stenosis, the first hea sound is usually loud and may be palpable (tapping apex beat) because of increased force in closing the mitral valve. The first hea sound is made by the mitral and tricuspid hea valves closing. These are normally synchronous, and the sounds are termed M1 and T1, respectively. M1 becomes louder in mitral stenosis. It may be the most prominent sign. If pulmonary hypeension secondary to mitral stenosis is severe, the P2 (pulmonic) component of the second hea sound (S2) will become loud. An opening snap that is a high-pitch additional sound may be heard after the A2 (aoic) component of the second hea sound (S2), which correlates to the forceful opening of the mitral valve. A mid-diastolic rumbling murmur with presystolic accentuation will be heard after the opening snap.The murmur is best heard at the apical region and is not radiated. Since it is a low-pitch sound, it is heard best with the bell of the stethoscope.Its duration increases with worsening disease.Rolling the patient toward left as well as isometric exercise will accentuate the murmur. A thrill might be present when palpating at the apical region of the precordium.