A 30-year-old woman with a history of mitral valve problems states that lately she has been "very tired." She has started waking up at night and feels like her "heart is pounding." During assessment,the nurse identifies a thrill and lift at the fifth left intercostal space midclavicular line.In the same area,the nurse also identifies a blowing,swishing sound right after S₁.These findings would be most consistent with:

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Subjective findings related to mitral regurgitation include fatigue,palpitation,and orthopnea.Objective findings are (1)a thrill in systole at apex;(2)lift at apex;(3)apical impulse displaced down and to the left;(4)S₁ diminished,S₂ accentuated,S₃ at apex often present;and (5)murmur: pansystolic,often loud,blowing,best heard at apex,radiating well to the left axilla.

A 30-Year-Old Woman with a History of Mitral Valve Problems