There are many diagnostic tests that have abnormal results in the presence of<unk> . These tests suggest the diagnosis of<unk>  and may indicate to the physician that further testing is warranted. For instance, the electrocardiogram (ECG) in long-standing<unk>  may show evidence of left atrial enlargement and left ventricular dilatation. Atrial fibrillation may also be noted on the ECG in individuals with chronic<unk> . The ECG may not show any of these findings in the setting of acute<unk> . + Comparison of acute and chronic phases of<unk>  Acute Chronic Electrocardiogram Normal P mitrale, Atrial fibrillation, left ventricular hypertrophy Heart size Normal Cardiomegaly, left atrial enlargement Systolic murmur Heard at the base, radiates to the neck, spine, or top of head Heard at the apex, radiates to the axilla Apical thrill May be absent Present Jugular venous distension Present Absent The quantification of<unk>  usually employs imaging studies such as echocardiography or magnetic resonance angiography of the heart. Chest X-ray The chest X-ray in individuals with chronic<unk>  is characterized by enlargement of the left atrium and the left ventricle, and then maybe calcification of the mitral valve. Echocardiogram Transesophageal echocardiogram of mitral valve prolapse 150px 150px Severe<unk>  Legend 1 Left atrium (LA) – 2<unk>  Jet, LV Left ventricle – RV Right ventricle – RA Right atrium Animation of a mitral valve regurgitation in a dog, left apical view. An echocardiogram is commonly used to confirm the diagnosis of<unk> . Color doppler flow on the transthoracic echocardiogram (TTE) will reveal a jet of blood flowing from the left ventricle into the left atrium during ventricular systole. Also, it may detect a dilated left atrium and ventricle and decreased left ventricular function. A transesophageal echocardiogram can give clearer images if needed as the back of the heart can also be viewed. Electrocardiography P mitrale is a broad, bifid notched P wave in several or many leads with a prominent late negative component to the P wave in lead V1, and may be seen in<unk> , but also in mitral stenosis, and, potentially, any cause of overload of the left atrium. Quantification of<unk>  The degree of severity of<unk>  can be quantified by the regurgitant fraction, which is the percentage of the left ventricular stroke volume that regurgitates into the left atrium. :regurgitant fraction = where Vmitral and Vaortic are, respectively, the volumes of blood that flow forward through the mitral valve and aortic valve during a cardiac cycle. Methods that have been used to assess the regurgitant fraction in<unk>  include echocardiography, cardiac catheterization, fast CT scan, and cardiac<unk> I. The echocardiographic technique to measure the regurgitant fraction is to determine the forward flow through the mitral valve (from the left atrium to the left ventricle) during ventricular diastole, and comparing it with the flow out of the left ventricle through the aortic valve in ventricular systole. This method assumes that the aortic valve does not suffer from aortic insufficiency. Another way to quantify the degree of<unk>  is to determine the area of the regurgitant flow at the level of the valve. This is known as the regurgitant orifice area and correlates with the size of the defect in the mitral valve. One particular echocardiographic technique used to measure the orifice area is measurement of the proximal isovelocity surface area (PISA). The flaw of using PISA to determine the mitral valve regurgitant orifice area is that it measures the flow at one moment in time in the cardiac cycle, which may not reflect the average performance of the regurgitant jet. + Determination of the degree of<unk>  Grade Degree of<unk>  Regurgitant fraction Regurgitant Orifice area 1 Mild 60 percent > 0.4 cm2
Mitral regurgitation
Aortic regurgitation
Tricuspid regurgitation
Mitral stenosis
Mitral valve prolapse
Aortic stenosis
Tricuspid valve stenosis
Systolic hypertension