Complex Murmurs

Mitral Regurgitation and Aortic Regurgitation Lesson #696

patient thorax when auscultating by stethoscope

The patient was sitting leaning forward during auscultation.

Description

A moderate regurgitation of both the aortic and mitral valves is presented in this lesson. 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. A rectangular murmur takes up most of systole, awhile 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 cardiac animation video, observe an enlarged left atrium and left ventricle. Also notice the regurgitant turbulent flow into the left atrium from the left ventricle (the systolic murmur) and regurgitant turbulent flow from the aorta into the left ventricular outflow tract (the diastolic murmur).

Phonocardiogram

Anatomy

Mitral Regurgitation and Aortic Regurgitation

Play the animation and take note of an enlarged left atrium and left ventricle. Observe regurgitant turbulent flow into the left atrium from the left ventricle (the systolic murmur) and regurgitant turbulent flow from the aorta into the left ventricular outflow tract (the diastolic murmur).

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