Physical exam-mitral-stenosis

• Low-pitched mid-diastolic rumble at apex w/ presystolic accentuation (if not in AF); best heard in L lat decubitus position during expiration, ↑ w/ exercise; severity proportional to duration (not intensity) of murmur; loud S 1
• Opening snap (high-pitched early diastolic sound at apex) from fused leaflet tips; MVA proportional to S2–OS interval (tighter valve → ↑ LA pressure → shorter interval)
• Loud S1 (unless MV calcified and immobile)