Mitral regurgitation is characterized by a holosystolic murmur that begins from S1 and continues to S2. This murmur is holosystolic because a faulty mitral valve allows blood to flow backwards to the left atrium during all of systole.
The murmur caused by mitral regurgitation is classically described as having a blowing quality.
This murmur is heard loudest at the apex of the heart, which is the lowest superficial part of the heart. On physical exam, the apex lies behind the fifth left intercostal space, usually 8-9 cm from the mid sternal line.
This murmur characteristically radiates towards the patient's left axilla and can help distinguish the murmur of mitral regurgitation from other heart murmurs.
This murmur is increased when there is increased total peripheral resistance like during squatting due to higher pressures that the left ventricle must pump against resulting in increased regurgitant blood flow.
This murmur is increased when there is increased total peripheral resistance like during hand grip due to higher pressures that the left ventricle must pump against resulting in increased regurgitant blood flow.
This left sided valvular disease can be distinguished from right sided tricuspid regurgitation because it becomes louder during expiration due to increase in venous return from the pulmonary veins to the left heart resulting in a large volume of blood that flows back to the left atrium.
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