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

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These findings are consistent with mitral regurgitation.Its subjective findings include fatigue,palpitation,and orthopnea,and its objective findings are: (1)a thrill in systole at the apex; (2)a lift at the apex; (3)the apical impulse displaced down and to the left; (4)the S? is diminished,the S? is accentuated,and the S? at the apex is often present; and (5)a pansystolic murmur that is often loud,blowing,best heard at the apex,and radiating well to the left axilla.

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