Complex Murmurs

Severe Mitral Regurgitation Lesson #692

patient thorax when auscultating by stethoscope

The patient was supine during auscultation.

Description

This lesson presents severe mitral regurgitation. The first heart sound is normal while the second heart sound is widely split. A third heart sound gallop follows S2. A loud, rectangular, pansystolic murmur is present. In addition, a brief, rumbling, diamond-shaped diastolic murmur immediately after the third heart sound.

In the cardiac anatomy video, you can see 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. Also notice the brief turbulent blood flow from the left atrium to the left ventricle during 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. Severe mitral regurgitation is often caused by degeneration of the mitral valve leaflets.

Phonocardiogram

Anatomy

Severe Mitral Regurgitation

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

Heart sounds by Dr. Jonathan Keroes, MD and David Lieberman, Developer, Virtual Cardiac Patient.
Lung sounds by Diane Wrigley, PA
Respiratory cases: William French
David Lieberman, Audio Engineering
Heart sounds mentorship by W. Proctor Harvey, MD
Special thanks for the medical mentorship of Dr. Raymond Murphy
Reviewed by Dr. Barbara Erickson, PhD, RN, CCRN.
Last Update: 11/10/2021

Sources

Heart and Lung Sounds Reference Library Diane S. Wrigley
Publisher: PESI
Impact Patient Care: Key Physical Assessment Strategies and the Underlying Pathophysiology
Diane S Wrigley & Rosale Lobo
Practical Clinical Skills: Lung Sounds
Essential Lung Sounds Diane S. Wrigley, PA-C
Published by MedEdu LLC
PESI Faculty - Diane S Wrigley
Case Profiles in Respiratory Care 3rd Ed, 2019
William A.French
Published by Delmar Cengage
Essential Lung Sounds by William A. French
Published by Cengage Learning, 2011
Understanding Lung Sounds Steven Lehrer, MD
Clinical Heart Disease W Proctor Harvey, MD
Clinical Heart Disease
Laennec Publishing; 1st edition (January 1, 2009)
Heart and Lung Sounds Reference Guide
PracticalClinicalSkills.com