Acute mitral regurgitation due to flail mitral leaflet mimicking: a diagnosis of pneumonia

The revolutionary introduction of echocardiography into clinical practice and the reduced emphasis in the teaching of physical diagnosis might have contributed to the gradual decline of cardiac auscultation skills [4]. When auscultation is routinely performed as an isolated aspect not integrated into a global examination, reliance on technology may force the physician to ask the “oracle” sonographer for a prophetic opinion on every murmur felt. A systolic murmur is detectable in 5–52 % of young adults and 29–60 % of older adults, but the rate of normal echocardiogram in these patients is 90 %and over 50 %, respectively [5]. Conversely, echocardiography performed in patients with murmurs not meeting the definition of a functional murmur (i.e. the murmur is too long or loud, is heard away from the sternal border, intensifies during the Valsalva strain, or is associated with abnormal cardiac findings), has a sensitivity of 70 %, specificity of 98 %, and a positive likelihood ratio of 38.3 for cardiac valve disease [6]. The accuracy of cardiac auscultation is thus not only a measure of the physician’s skill and experience but also a help to public health spending.