Question
A case of severe mitral stenosis is associated with all of the following features, EXCEPT:
| A. |
Pulsatile liver |
| B. |
Atrial fibrillation |
| C. |
Opening snap delayed from S2 |
| D. |
Increase in the length of murmur |
|
Correct Answer » A Explanation |
 |
Pulsatile liver is a sign of tricuspid regurgitation or severe right heart failure with elevated right atrial pressure causing hepatic vein pulsations, not directly caused by mitral stenosis.
– In severe MS, right heart failure may develop but pulsatile liver per se is not a characteristic direct finding of mitral stenosis.
– Atrial fibrillation is common due to LA enlargement and high pressure.
– The opening snap of the mitral valve is delayed as the valve orifice narrows and the LA to LV pressure gradient delays valve opening after S2.
– Murmur length increases as severity worsens because the diastolic pressure gradient between LA and LV persists for longer.