Which feature best describes a mitral stenosis murmur?

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Mitral stenosis produces a diastolic, low-pitched rumbling murmur best heard at the apex with the patient in the left lateral decubitus position. The murmur begins after the opening snap (from the mitral valve opening) and becomes louder with expiration as more blood flows across the narrowed orifice. This diastolic timing and the characteristic rumble are the key clues that distinguish it from other murmurs.

The other murmurs described point to different valvular problems: a holosystolic murmur radiating to the axilla reflects mitral regurgitation; a high-pitched systolic murmur at the left sternal border suggests aortic stenosis (or a similar systolic outflow murmur); and a continuous murmur along the left sternal border is typical of a patent ductus arteriosus.