This is an auscultation example of moderate regurgitation of both the aortic and mitral valves.

The first heart sound is minimally decreased due to minimal closure of the mitral valve leaflets in early systole. The second heart sound is normal.

There is a rectangular murmur which takes up most of systole and a decrescendo murmur which takes up most of diastole. Both murmurs are of moderate intensity.

The combination of the two murmurs creates a to-and-fro sound character.

In the anatomy tab you see an enlarged left atrium and left ventricle.

You see regurgitant turbulent flow into the left atrium from the left ventricle (the systolic murmur) and regurgitant turbulent flow from the aorta into the left ventrilcular outflow tract (the diastolic murmur).