This patient has a holosystolic murmur at the apex together with a low frequency mid diastolic murmur. The systolic murmur begins with S1, indicating that it represents mitral regurgitation or radiation of the murmur of either a ventricular septal defect or tricuspid regurgitation. The mid diastolic murmur occurs at the time of rapid ventricular filling. I usually implies excessive flow into the left ventricle, but occasionally, occurs with normal flow into a ventricle with decreased compliance. Note that this acoustic event is a murmur, not simply an S3.