04/30/2026
The mitral valve regulates blood flow from the left atrium to the left ventricle. When its function is impaired, characteristic acoustic patterns can be identified.
1. Mitral Regurgitation (Insufficiency)
Occurs when the valve leaflets (anterior or posterior) fail to achieve complete coaptation, allowing blood to flow backward into the left atrium during systole.
Clinical acoustic finding:
A systolic murmur, typically holosystolic (pansystolic), with a blowing quality.
Point of evaluation:
Best perceived at the cardiac apex (5th intercostal space along the left midclavicular line).
Radiation: The acoustic pattern often extends toward the left axilla.
2. Mitral Stenosis
Characterized by narrowing of the valve or***ce due to leaflet thickening, fusion, or annular fibrosis, leading to impaired left ventricular filling.
Clinical acoustic findings:
Mitral stenosis produces diastolic low-frequency acoustic patterns, typically including:
A mid-diastolic rumble
A late diastolic accentuation (presystolic) in the presence of coordinated atrial contraction
Additional signs:
An opening snap (OS) following S2
Increased intensity of the pulmonary component of S2, reflecting elevated pulmonary pressures
☝️Note: In the presence of atrial fibrillation, atrial contraction is absent; therefore, presystolic accentuation is not present.
3. Mitral Valve Prolapse (MVP)
Occurs when one or both mitral leaflets (more commonly the posterior leaflet) displace into the left atrium during ventricular contraction.
Clinical acoustic finding:
A characteristic mid-systolic click, often followed by a late systolic murmur, reflecting tension on the valve apparatus and variable regurgitant flow.
📑Why is this clinically relevant?
The subvalvular apparatus — particularly the chordae tendineae and papillary muscles — plays a critical role in valve competence.
For example, chordae tendineae rupture can result in acute mitral regurgitation, generating an intense and often complex systolic acoustic pattern due to abrupt hemodynamic changes and turbulent flow.