Which of the following is not a clinical sign associated with mitral stenosis?

Malar flush, atrial fibrillation, and a tapping apex beat which occurs secondary to pulmonary hypertension, are all clinical signs associated with mitral stenosis. On auscultation of the precordium, a mid- diastolic murmur (±opening snap, representing a mobile valve) is heard rather than a pan-systolic murmur which is usually heard in mitral regurgitation, tricuspid regurgitation and ventricular septal defects.