Mitral incompetence
Rheumatic etiology is the commonest cause in developing countries. It takes several years to develop mitral valvular lesions. The typical symptoms are due to pulmonary edema and reduced cardiac output. The specific clinical signs are: displaced apex beat out side the midclavicular line and apical pansystolic murmur radiating towards the axilla. The chest x-ray shows: enlarged left atrium, prominent pulmonary conus, enlarged left ventricle making the straight left heart border and plethoric lung fields.