A systolic murmur was noted and an urgent transoesophageal echocardiogram was performed (top, transgastric view; MV, mitral valve; LV, left ventricle; LA, left atrium).
[heart.bmj.com]
His pathologic murmur (systolic murmur that is heard in the apex, radiates to the axilla, increases with the grip maneuver, and decreases with Valsalva) is characteristic
[usmleforum.com]
In each case severe mitral regurgitation was suggested by the sudden appearance of a systolic murmur followed by progressive congestive heart failure.
[nejm.org]