A moderate regurgitation of both the aortic and mitral valves is presented in this lesson. The first heart sound is minimally decreased due to minimal closure of the mitral valve leaflets in early systole. The second heart sound is normal. A rectangular murmur takes up most of systole, awhile a decrescendo murmur which takes up most of diastole. Both murmurs are of moderate intensity. The combination of the two murmurs creates a to-and-fro sound character. In the cardiac animation video, observe an enlarged left atrium and left ventricle. Also notice the regurgitant turbulent flow into the left atrium from the left ventricle (the systolic murmur) and regurgitant turbulent flow from the aorta into the left ventricular outflow tract (the diastolic murmur).
Listen

The patient's position is sitting leaning forward.