From the Guidelines
A mitral valve murmur is best heard at the cardiac apex, which is located in the fifth intercostal space at the midclavicular line on the left side of the chest. When auscultating for a mitral valve murmur, it is essential to use the bell of the stethoscope with the patient in the left lateral decubitus position, as this brings the apex closer to the chest wall and enhances the murmur's audibility 1. The characteristics of the murmur, such as its timing, configuration, location, and radiation, are crucial in differentiating mitral valve murmurs from other cardiac murmurs.
Some key points to consider when auscultating for a mitral valve murmur include:
- The murmur is usually medium to high-pitched and loudest at the cardiac apex 1
- The murmur may have a musical or honking quality 1
- The character and intensity of the murmur can vary under certain conditions, from brief and almost inaudible to holosystolic and loud 1
- Dynamic auscultation is often useful for establishing the diagnosis of mitral valve prolapse syndrome 1
It is also important to note that the timing of mitral valve murmurs varies by pathology, with mitral regurgitation producing a holosystolic murmur and mitral stenosis creating a diastolic rumbling murmur. The location and characteristics of the murmur are essential for accurate diagnosis of valvular heart disease. The guidelines for the management of patients with valvular heart disease, as outlined in the ACC/AHA 2006 guidelines, emphasize the importance of echocardiography in the evaluation and treatment of patients with valvular heart disease 1.
From the Research
Location of Mitral Valve Murmur
- A mitral valve murmur is typically heard at the apex of the heart, which is located at the fifth intercostal space, mid-clavicular line [ 2 ].
- The murmur can be heard during systole, which is the period of the cardiac cycle when the heart muscle contracts and pumps blood out of the heart [ 2 ].
- The intensity and configuration of the murmur can vary depending on the underlying cause of the mitral regurgitation, such as mitral valve prolapse or rheumatic heart disease [ 3, 2 ].
Associated Conditions
- Mitral valve murmur can be associated with other conditions, such as aortic stenosis, which can lead to complex pathophysiology and diagnostic challenges [ 4 ].
- Mitral regurgitation can also be present in patients with transcatheter aortic valve replacement, and its presence can impact the outcomes of the procedure [ 5 ].
- Mitral valve prolapse is a condition that can lead to mitral regurgitation, and its prevalence and progression can vary across different populations and age groups [ 6 ].