Mitral Regurgitation - Severe

This is an example of severe mitral regurgitation which is caused by degeneration of the mitral valve leaflets. The first heart sound is normal. The second heart sound is widely split. Following the second heart sound there is a third heart sound gallop. There is a loud, rectangular, pansystolic murmur. There is a brief, rumbling, diamond-shaped diastolic murmur immediately following the third heart sound. In the anatomy video you can see the enlarged left atrium and left ventricle. You can see the turbulent blood flow from the left ventricle into the left atrium. This is the systolic murmur. You can see the brief turbulent blood flow from the left atrium to the left ventricle in diastole. This is caused by too much blood in the left atrium which forces blood back into the ventricle during diastole producing the flow rumble.

Auscultation Sounds

Patient Recording

Patient Recording - Half Speed

Position

The patient's position should be supine.

Listening Tips

Systole:Rectangular, loud murmur
S2:Widely split
Diastole:S3 followed by a diamond shaped, brief murmur

Waveform (Phonocardiogram)

Observe Cardiac Animation

Review the cardiac animation and notice the enlarged left atrium and left ventricle. Observe the turbulent blood flow from the left ventricle into the left atrium. This is the systolic murmur. You can see the brief turbulent blood flow from the left atrium to the left ventricle in diastole. This is caused by too much blood in the left atrium which forces blood back into the ventricle during diastole producing the flow rumble.

Authors and Sources

Authors and Reviewers

EKG heart rhythm modules: Thomas O'Brien.
EKG monitor simulation developer: Steve Collmann
12 Lead Course: Dr. Michael Mazzini, MD.
Spanish language EKG: Breena R. Taira, MD, MPH
Medical review: Dr. Jonathan Keroes, MD
Heart sounds and mentorship: W. Proctor Harvey, MD
Medical review: Dr. Pedro Azevedo, MD, Cardiology
Last Update: 1/8/2023

Sources

Electrocardiography for Healthcare Professionals, 5th Edition Kathryn Booth and Thomas O'Brien
ISBN10: 1260064778, ISBN13: 9781260064773
McGraw Hill, 2019
Rapid Interpretation of EKG's, Sixth Edition
Dale Dublin
Cover Publishing Company
12 Lead EKG for Nurses: Simple Steps to Interpret Rhythms, Arrhythmias, Blocks, Hypertrophy, Infarcts, & Cardiac Drugs
Aaron Reed
Create Space Independent Publishing
Heart Sounds and Murmurs: A Practical Guide with Audio CD-ROM 3rd Edition
Elsevier-Health Sciences Division
Barbara A. Erickson, PhD, RN, CCRN
Clinical Heart Disease W Proctor Harvey, MD
Clinical Heart Disease
Laennec Publishing; 1st edition (January 1, 2009)
The Virtual Cardiac Patient: A Multimedia Guide to Heart Sounds, Murmurs, EKG Jonathan Keroes, David Lieberman
Publisher: Lippincott Williams & Wilkin)
ISBN-10: 0781784425; ISBN-13: 978-0781784429
Project Semilla, UCLA Emergency Medicine, EKG Training Breena R. Taira, MD, MPH

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Mitral Regurgitation - Severe | Lessons with Audio and Video | #101