Severe mitral regurgitation
by Franklin B Saksena, Ranganathan Narasimhan, Sivaciyan Vahe

The Art and Science of Cardiac Physical Examination (With Heart Sounds, Jugular and Precordial Pulsations)

by Narasimhan Ranganathan, Vahe Sivaciyan, Franklin B Saksena
About Video

This recording is from a patient with severe mitral regurgitation at the 2nd right interspace. The murmur is quite loud even at the base as shown from the 2nd right interspace. Careful listening of the recording will show that the murmur to end with a split S2. Since the mitral regurgitation murmur often extends all the way to the S2 and spills into the isovolumic relaxation phase, if any S2 split is heard, it probably will indicate a somewhat wide split. Severe mitral regurgitation may sometimes cause a wide split S2 due to an early A2. This is because the Starling effect of the increased volume received by the left ventricle during diastole will result in very rapid ejection by the left ventricle. This very rapid ejection may result in an early A2 causing a wide separation of the two components of the S2.

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