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AIR: WHAT: Murmur of MI (mitral insufficiency). Murmur of Mitral Insufficiency: an apical systolic murmur caused by the flow of blood from the left ventricle through a damaged mitral valve into the left atrium during systole. WHY: The murmur of mitral regurgitation is the most common sign of carditis seen with rheumatic fever. HOW: The murmur of mitral insufficiency is a loud, high pitched, blowing murmur filling most of systole. It is heard best in the apical region and is transmitted to the left axilla. It is heard best with the diaphragm of the stethoscope pressed firmly against the chest. Unlike the innocent functional systolic murmur with which it is most confused, the murmur of mitral insufficiency does not change with changes in the patient's position or phases of respiration. Occasionally, an apical mid-diastolic murmur is also present with the systolic murmur of mitral insufficiency. The mid-diastolic murmur is low pitched, begins immediately after the third heart sound and ends before the first hear
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