A Mitral stenosis patient has developed pulmonary aery hypeension. Which of the following auscultatory findings may be heard?

With severe pulmonary hypeension, a pansystolic murmur produced by functional TR may be audible along the left sternal border. This murmur is usually louder during inspiration and diminishes during forced expiration (Carvallo's sign). When the CO is markedly reduced in MS, the typical auscultatory findings, including the diastolic rumbling murmur, may not be detectable (silent MS), but they may reappear as compensation is restored. TheGraham Steell murmurof PR, a high-pitched, diastolic, decrescendo blowing murmur along the left sternal border, results from dilation of the pulmonary valve ring and occurs in patients with mitral valve disease and severe pulmonary hypeension. Choice 1 is wrong because it is written crescendo while in PAH early diastolic decresendo murmur occurs. Choice 2 is ruled out as it is seen in AS PAH in MS leads to decompensation of RV. The dilated RV leads to TR and a pansystolic murmur will result. Choice 4 is seen in Mitral stenosis.