Clinical features of mitral incompetence

In cases of mild regurgitation, the patient may be asymptomatic. Ventricular ectopics may occur in patients with prolapsing mitral valves. There are often non-specific chest pains in patients with prolapsing valves but these are usually skeletal in origin and are exaggerated by anxiety.

When left ventricular failure occurs then the patient will complain of symptoms of dyspnoea on exertion, orthopnoea and paroxysmal nocturnal dyspnoea. If there is associated angina on exertion then this makes ischaemic heart disease likely to be the cause of the mitral regurgitation.

Signs of mitral incompetence:

• pulse, which may be fibrillating
• JVP raised only if heart failure
• right and left ventricular hypertrophy.
• soft S1; loud P2 if there is pulmonary hypertension
• high frequency pan systolic murmur best heard in the apex and radiating to the axilla.

A soft blowing pansystolic murmur with a reduced or absent S1, radiating to the axilla and back, heard best at the apex, especially in the left lateral position with the breath held in expiration.