In this heart sound, a grade 2 systolic murmur is audible. It was ausculted over the right AV valve region. The murmur is a plateau (band-shaped) and occurs throughout systole, making it difficult to identify S1 or S2.
This 11-year-old Maltese had severe tracheal collapse and secondary pulmonary hypertension. The murmur was likely caused by degenerative changes to the tricuspid valve. However, because of the presence of pulmonary hypertension, the tricuspid insufficiency murmur was of higher than normal velocity and easier to auscult over the right AV valve than most patients with degenerative tricuspid valve disease.