A 65-year-old patient presents with a history of
palpitations and breathlessness. She gives a history of Sydenham’s chorea as
a child. On examination she has a pulse rate of 120 beats per minute rhythm;
irregularly irregular, small volume. JVP not elevated, apex beat not
displaced, tapping in nature. There is left parasternal heave, the first and
second heart sounds are loud and there is an opening snap and a low-pitched
rumbling mid-diastolic murmur.
Which of the following physical signs suggest that a
complication of her condition has occurred?
Loud first heart sound
Loud second heart sound