Images in Clinical Medicine

A Grade 6 Systolic Murmur

David H. Spodick, M.D., D.Sc., and A. Thomas Pezzella, M.D.

N Engl J Med 1999; 341:27July 1, 1999

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Figure 1 A 30-year-old man who had been treated for staphylococcal endocarditis superimposed on a prolapsing mitral valve had a residual grade 6 mitral systolic murmur that was easily audible without a stethoscope. A two-dimensional echocardiogram showed prolapsing flail mitral leaflets with attached material resulting from the endocarditis (Panel A). AML denotes anterior mitral leaflet, and PML posterior mitral leaflet. Attached material from vegetations and prolapse is evident on an M-mode echocardiogram (Panel B) obtained through the mitral valve shown in Panel A. The arrows indicate coarse oscillations coincident with the grade 6 mitral systolic murmur.

David H. Spodick, M.D., D.Sc.
A. Thomas Pezzella, M.D.
St. Vincent Hospital, Worcester, MA 01604-4593

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