Fatigue, weakness, and exertional dyspnea. Physical examination: sharp low-volume upstroke of carotid arterial pulse, LV lift, S1 diminished: wide splitting of S2; S3 common; loud holosystolic murmur at the apex (less than holosystolic in acute severe MR) and often a brief early-mid-diastolic murmur due to increased transvalvular flow.