Article Text

Download PDFPDF
Murmur on top of the head: bioprosthetic mitral valve insufficiency
  1. Albahi Malik1,
  2. Aneeqa Saif1,
  3. Awsse Al-Ani1 and
  4. Christopher Haas1,2,3
  1. 1Department of Medicine, MedStar Health, Baltimore, Maryland, USA
  2. 2Department of Internal Medicine, MedStar Harbor Hospital, Baltimore, Maryland, USA
  3. 3Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, Maryland, USA
  1. Correspondence to Dr Albahi Malik; albahi.malik{at}


In 1961, K Merendino ‘in pure curiosity’, while tracking the murmur of mitral regurgitation, placed his stethoscope ‘on the vertex of the head’, and ultimately led to a medical curiosity and exam finding that not only bears his name, but awes medical learners at all stages of their careers. Merendino and colleagues collected seven such cases of the ‘Murmur on Top of the Head’ building on the work of others who provided a detailed description of mitral regurgitation and noted murmur radiation to the neck and cervical/lumbosacral spine. The majority of patients suffered from rheumatic heart disease or subacute bacterial endocarditis in native heart valves. Here, we report on a case of the ‘Murmur on Top of the Head’ and provide the reader/listener with a direct recording of the ‘Merendino murmur’ (as well as its spinal correlate) in an elderly woman with a bioprosthetic mitral valve.

  • valvar diseases
  • clinical diagnostic tests
  • radiology (diagnostics)

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors AM: wrote the case reports. AS: wrote part of the report. AA-A: review the paper. CH: mentored, reviewed and was part of planning of the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.