In moderate or severe cases the left atrium tends to dilate and hypertrophy. However, the atria muscle is thin and may be affected by thematic myocarditis, so that back pressure soon leads to pulmonary congestion and pulmonary hypertension and in time to dilatation, hypertrophy and eventually failure of the right side of the heart. Atria fibrillation is very common and adds to the disability. Long- standing pulmonary congestion is responsible for the dyspnoea so characteristic of mitral stenos is. Attacks of acute pulmonary edema may occur but are less common than in left ventricular failure. Palpitation is often a distressing complaint and cough may be very troublesome. Haemoptysis may occur, especially in those with severe pulmonary hypertension.
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