Mitral Regurgitation and Aortic Regurgitation | #105

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 video 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 ventricular outflow tract (the diastolic murmur).

Auscultation Sounds

Position

The patient's position should be sitting leaning forward.

Listening Tips

S1:Minimally reduced intensity
Systole:Rectangular murmur, moderate intensity
Diastole:Decrescendo murmur, moderate intensity

Waveform (Phonocardiogram)

Observe Cardiac Animation

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

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 and Aortic Regurgitation | #105