We have reviewed the classic holosystolic plateau-shaped murmur of rheumatic mitral regurgitation and the mid-to-late systolic crescendo murmur of mitral valve prolapse. Additional variations may also occur.

In patients with papillary muscle dysfunction, the configuration can vary, for example, it may be mid systolic and crescendo-decrescendo.

In patients with acute mitral regurgitation, the murmur may be systolic and decrescendo. In this circumstance, the early systolic pressure rise in the left atrium diminishes late systolic regurgitation.

The murmur of mitral regurgitation is systolic and almost always high in frequency and best heard at the apex.

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