Family Nurse Practitioner Exam

Where is mitral regurgitation best heard during a physical exam?

1. The apical area during S2

2. At the base at S1

3. At the apex at S1

4. At the base at S2

The correct answer is: At the apex at S1

Mitral regurgitation is best heard at the apex of the heart during the S1 phase of the cardiac cycle. The apex is located in the left fifth intercostal space, midclavicular line, where the heart's apex beat can be palpated. During mitral regurgitation, blood flows back from the left ventricle into the left atrium during ventricular systole, producing a characteristic holosystolic (or pansystolic) murmur. This murmur is distinctively recognized as it occurs immediately after S1, coinciding with the closure of the mitral valve, which in cases of regurgitation, does not effectively stop blood from flowing back into the atrium. The turbulence created by the regurgitant flow results in a sound that is optimally audible at the apex, hence making this location the best choice for auscultation. In contrast, options that involve the base of the heart are less relevant for mitral regurgitation, as the sounds produced there are typically associated with other cardiac conditions or murmurs originating from different valves, such as the aortic or pulmonic valves. The timing of S2 is also less pertinent for detecting the characteristic murmur of mitral regurgitation,