A 60y.o. female complaining of dyspnea and arrythmia with diastolic murmur, what are the possibilities?

Valvular heart disea: In a female particularly if not born in the us a cardiac arrhythmia particularly atrial fib associated with a diastolic murmur suggest mitral stenosis . Non af and diastolic murmur suggest aortic insufficiency which still may be due to rheumatic heart disease . Physical examination is diagnostic and 2d echo is confirmatory.