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BOF: 2.16

A 60-year-old female presents with a history of fatigue. On examination she has a regular pulse, rate 80 beats per minute, jerky in character. The JVP is not elevated her apex beat is displaced and thrusting in nature. On auscultation there is a 3^rd heart sound and there is a pan systolic murmur at the apex radiating to the axilla. Lung bases are clear.

In this patient which of the following physical signs suggests that the mitral regurgitation is severe?

a)      Jerky pulse

b)    Thrusting apex

c)      3^rd heart sound

d)      Pan systolic murmur at the apex

e)      Murmur radiating to the axilla

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