Mitral regurgitation physical examination

Jump to navigation Jump to search

WikiDoc Resources for Mitral regurgitation physical examination

Articles

Most recent articles on Mitral regurgitation physical examination

Most cited articles on Mitral regurgitation physical examination

Review articles on Mitral regurgitation physical examination

Articles on Mitral regurgitation physical examination in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Mitral regurgitation physical examination

Images of Mitral regurgitation physical examination

Photos of Mitral regurgitation physical examination

Podcasts & MP3s on Mitral regurgitation physical examination

Videos on Mitral regurgitation physical examination

Evidence Based Medicine

Cochrane Collaboration on Mitral regurgitation physical examination

Bandolier on Mitral regurgitation physical examination

TRIP on Mitral regurgitation physical examination

Clinical Trials

Ongoing Trials on Mitral regurgitation physical examination at Clinical Trials.gov

Trial results on Mitral regurgitation physical examination

Clinical Trials on Mitral regurgitation physical examination at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Mitral regurgitation physical examination

NICE Guidance on Mitral regurgitation physical examination

NHS PRODIGY Guidance

FDA on Mitral regurgitation physical examination

CDC on Mitral regurgitation physical examination

Books

Books on Mitral regurgitation physical examination

News

Mitral regurgitation physical examination in the news

Be alerted to news on Mitral regurgitation physical examination

News trends on Mitral regurgitation physical examination

Commentary

Blogs on Mitral regurgitation physical examination

Definitions

Definitions of Mitral regurgitation physical examination

Patient Resources / Community

Patient resources on Mitral regurgitation physical examination

Discussion groups on Mitral regurgitation physical examination

Patient Handouts on Mitral regurgitation physical examination

Directions to Hospitals Treating Mitral regurgitation physical examination

Risk calculators and risk factors for Mitral regurgitation physical examination

Healthcare Provider Resources

Symptoms of Mitral regurgitation physical examination

Causes & Risk Factors for Mitral regurgitation physical examination

Diagnostic studies for Mitral regurgitation physical examination

Treatment of Mitral regurgitation physical examination

Continuing Medical Education (CME)

CME Programs on Mitral regurgitation physical examination

International

Mitral regurgitation physical examination en Espanol

Mitral regurgitation physical examination en Francais

Business

Mitral regurgitation physical examination in the Marketplace

Patents on Mitral regurgitation physical examination

Experimental / Informatics

List of terms related to Mitral regurgitation physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Palpation

Arterial Pulse: Watson's water hammer pulse or bounding pulse- brisk upstroke followed by rapid fall off of arterial pulse. However volume of pulse may be decreased in presence of heart failure.

Blood pressure: Wide pulse pressure

Apical impulse: Brisk and hyperdynamic and may be displaced leftwards secondary to left ventricular enlargement.

Auscultation

Heart Sound:

  • S1 is usually diminished due to failure of mitral valves to close properly.
  • S2 is commonly widely split due to shorter time duration of left ventricular ejection and early A2.
  • P2 is louder than A2 in presence of severe pulmonary hypertension.
  • S3 may also be heard due to rapid filling of left ventricle. S3 in this case should not be interpreted as a feature of heart failure.

Murmur:

Quality: High pitched and blowing. Best heard with diaphragm of stethoscope with patient in left lateral dicubitus position. Location: Usually best heard over the apical region with radiation to left axilla and left subscapular area.

  • Posterior leaflet dysfunction murmur radiate to sternum or aortic area.
  • Anterior leaflet dysfunction murmur radiate to back.

Duration:

  • In the presence of an incompetent mitral valve, the pressure in the left ventricle becomes greater than that in the left atrium at the onset of isovolumic contraction, which corresponds to the closing of the mitral valve (S1). This explains why the murmur in mitral regurgitation starts at the same time as S1. This difference in pressure extends throughout systole and can even continue after the aortic valve has closed, explaining how it can sometimes drown the sound of S2. Hence named Holosystolic Murmur
  • If the murmur is heard in late systolic phase, it may be due to mitral valve prolapse or papillary muscle dysfunction. In these cases, S1 will probably be normal since initial closure of mitral valve cusps is unimpeded.
  • Mid systolic click is suggestive of mitral valve prolapse

Effect of Maneuvers: Murmur of mitral regurgitation may be difficult to distinguish from that of other valves' diseases. Certain maneuvers may be helpful in this regard.

  • Respiration: There is little variation on intensity of mitral regurgitation murmur with respiration. However in some, there is increase in intensity of murmur during expiration.
  • Valsalva Maneuver: The intensity of mitral regurgitation murmur decreases with valsalva maneuver as the venous return to heart is reduced. However in mitral regurgitation due to mitral valve prolapse, systolic murmur becomes longer and often louder.


References

Template:WH

Template:WS