What are the key clinical features to consider when assessing a patient for mitral regurgitation?

When assessing a patient for mitral regurgitation, key clinical features to consider include the presence and characteristics of a murmur, symptoms such as breathlessness and angina, signs of heart failure like peripheral oedema, and any history of atrial fibrillation or syncope. A systolic murmur, particularly if associated with exertional syncope or severe symptoms (angina or breathlessness on minimal exertion or at rest), warrants urgent specialist assessment and echocardiography to evaluate the severity of mitral regurgitation ¹.

Additional clinical features include the detection of an abnormal ECG and the presence of a reduced second heart sound alongside the murmur, which may indicate valve disease ¹. Symptoms of heart failure should be carefully assessed, as they influence management decisions. Echocardiography remains the primary diagnostic tool, but cardiovascular magnetic resonance imaging (CMR) can provide complementary detailed assessment of mitral regurgitation severity and ventricular function, especially when echocardiographic findings are inconclusive (Botis et al., 2024).

Family history, age (particularly over 75 years), and medical history are important contextual factors that may raise suspicion of mitral valve disease and guide the need for further investigation ¹. In summary, the key clinical features are the nature of the murmur, symptoms of breathlessness or angina, signs of heart failure, syncope, and relevant history, all supported by echocardiographic and potentially CMR imaging findings to confirm diagnosis and severity ¹ (Botis et al., 2024).