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The first heart sound, or S 1, forms the "lub" of "lub-dub" and is composed of components M 1 (mitral valve closure) and T 1 (tricuspid valve closure). Normally M 1 precedes T 1 slightly. It is caused by the closure of the atrioventricular valves , i.e. tricuspid and mitral (bicuspid), at the beginning of ventricular contraction, or systole .
One may hear it at the left lower sternal border. A palpable S2 in the second left intercostal space correlates with pulmonary hypertension due to mitral stenosis. The cooing dove murmur is a cardiac murmur with a musical quality (high pitched). Associated with aortic valve regurgitation (or mitral regurgitation before rupture of chordae).
The mitral valve is typically 4 to 6 square centimetres (0.62 to 0.93 sq in) in area and sits in the left heart between the left atrium and the left ventricle. [5] It has two cusps: an anterior one, and a posterior one. [6] The opening of the mitral valve is surrounded by a fibrous ring known as the mitral annulus. The anterior cusp attaches to ...
Upon auscultation of an individual with mitral valve prolapse, a mid-systolic click, followed by a late systolic murmur heard best at the apex, is common. The length of the murmur signifies the time period over which blood is leaking back into the left atrium, known as regurgitation.
The mitral valve in cases of mitral stenosis may open with an opening snap [1] [2] on the beginning of diastole. Patients with mitral valve prolapse may have a mid-systolic click along with a murmur, referred to as apical late systolic murmur. [3] Early systolic clicks may also be present in some patients. [4]
Mitral regurgitation, also known as mitral insufficiency or mitral incompetence, is the backward flow of blood from the left ventricle, through the mitral valve, and into the left atrium, when the left ventricle contracts, resulting in a systolic murmur radiating to the left armpit.
Mitral valve prolapse: This is the most common cause of late systolic murmurs. It can be heard best over the apex of the heart, usually preceded by clicks. The most common cause of mitral valve prolapse is "floppy" valve (Barlow's) syndrome. If the prolapse becomes severe enough, mitral regurgitation may occur.
Increased flow across the atrioventricular valve This can also produce a mid-diastolic murmur, such as in severe mitral regurgitation where a large regurgitant volume in the left atrium can lead to "functional mitral stenosis." Mid-diastolic Austin Flint murmur: An apical diastolic rumbling murmur in patients with pure aortic regurgitation.