Which of the following is an indication of severe mitral stenosis in patients?

Severe mitral stenosis is characterized by a significant narrowing of the mitral valve opening, leading to impaired blood flow from the left atrium to the left ventricle during diastole. This condition often results in increased pressure in the left atrium and pulmonary circulation, which can cause various symptoms.

Fatigue with exertion is a common and important clinical manifestation in patients with severe mitral stenosis. As the heart struggles to pump blood effectively due to the narrowed valve, patients often experience decreased cardiac output during physical activity, which contributes to feelings of fatigue. The demand for oxygen by the body increases with exertion, but the limited blood flow makes it difficult for patients to meet these demands, leading to increased fatigue.

In contrast, minor wheezing may not be a definitive sign or indication of severe mitral stenosis, as it can be attributed to other conditions such as asthma or chronic obstructive pulmonary disease. Increased exercise tolerance is not expected in severe mitral stenosis; in fact, patients typically have reduced exercise capacity. Additionally, a regular heart rhythm does not indicate disease severity; in many cases of mitral stenosis, arrhythmias such as atrial fibrillation can occur. Therefore, fatigue with exertion is the most