Page 135 - Clinical Pearls in Cardiology

Valvular Heart Diseases 123

chronic heart disease. Such a massive heart is known as
cor bovinum (bovine or ox heart).
33. What are the clinical features of chronic mitral
regurgitation?
Table 5: Clinical features of chronic mitral regurgitation
• Fatigue due to low cardiac output
History • Dyspnea due to progressive left ventricular
dysfunction
Pulse • Small water hammer pulse
• Apical impulse displaced downwards and outwards
Precordial • Hyperdynamic apical impulse
impulses
• Systolic apical thrill usually present
• Soft S1
Heart • Wide mobile split of S2
sounds
• S3 in severe MR with left ventricular dysfunction
• High-pitched blowing holosystolic murmur in the
apical area
• The murmur radiates to the axilla and interscapular
Murmurs area in case of anterior cusp involvement and to the
base of the heart in case of posterior cusp involvement
• Short early to mid-diastolic flow murmur in the apical
area

Note: The murmur of mitral regurgitation is best heard in the left lateral
recumbent position with the diaphragm of the stethoscope and with
the breath held in expiration