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 S₁.These findings would be most consistent with:

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Mitral regurgitation subjective findings 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