Physical Examination


  • Location: best audible with the diaphragm at the apex
  • Description: blowing, high-pitched holosystolic regurgitant murmur
  • Radiation: typically into the left axilla
  • Maneuvers: augmented during expiration or isometric handgrip
  • Variations :
  • MR due to posterior leaflet prolapse may be anteriorly directed toward the left sternal border
  • MR may not be holosystolic in the following settings
  • Murmurs of MR may be early systolic with acute severe MR due to rapid equalization of LA and LV pressures
  • Murmurs of MR may be mid-to-late systolic following a click in MVP
  • Murmurs of MR may be late systolic in ischemic MR due to papillary muscle dysfunction
  • Associated findings
  • Laterally displaced PMI
  • Soft S1 ± S3
  • P2 component may be augmented when pulmonary hypertension occurs

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