What are the key clinical features to consider when assessing a patient for mitral stenosis?

When assessing a patient for mitral stenosis, key clinical features to consider include symptoms such as exertional dyspnoea, fatigue, and palpitations due to atrial fibrillation, which are common presentations reflecting impaired left atrial emptying and pulmonary congestion NICE NG208. On examination, a characteristic low-pitched, rumbling diastolic murmur best heard at the apex with the patient in the left lateral position is a hallmark sign, often preceded by an opening snap following the second heart sound, indicating restricted mitral valve leaflet motion NICE NG208. Additional signs may include a loud first heart sound and evidence of pulmonary hypertension such as a loud pulmonary component of the second heart sound NICE NG208. Clinical features may also include signs of right heart failure in advanced disease, such as peripheral oedema and raised jugular venous pressure NICE NG208. Echocardiographic assessment is essential to confirm the diagnosis and evaluate severity, showing thickened mitral leaflets with restricted mobility and reduced mitral valve area, often due to rheumatic heart disease Jain & Mankad 2013. The literature emphasizes the importance of correlating clinical findings with echocardiographic features to guide management effectively Jain & Mankad 2013.