text: Chronic compensated mitral regurgitation (MR) causes a blowing holosystolic murmur which radiates to the left axilla. In acute severe MR, the murmur can be early systolic rather than the typical holosystolic murmur in chronic MR due to the abrupt elevation in the pressure in the left atrium and the equalization of pressures between the left atrium and left ventricle. The intensity of the murmur decreases with valsalva maneuver and standing and becomes louder with hand grip, squatting, and leg raising.  The murmur might be short or absent in severe acute MR.  In addition, S1 is usually diminished and S2 is commonly widely split.  The pulmonic component of the second heart sound (P2) is louder than the aortic component (A2) in the presence of severe pulmonary hypertension thus widening the splitting of S2.
option_0: Mitral regurgitation physical examination
option_1: Mitral stenosis physical examination
option_2: Tricuspid regurgitation physical examination
option_3: Aortic regurgitation physical examination
option_4: Tricuspid stenosis physical examination
option_5: Mitral valve prolapse physical examination
option_6: Bicuspid aortic stenosis physical examination
option_7: Pulmonic regurgitation physical examination