Ruptured chordae tendineae result in moderate to severe valvular incompetence. Diagnosis is first based on auscultation of the characteristic murmur of MR or TR. Signs which may alert the clinician to the specific diagnosis of ruptured chordae tendineae include a history of a sudden deterioration of clinical signs, or the acute onset of clinical signs of heart disease in animals with no previously known disease. In some cases the murmur is particularly harsh, with a coarse vibrant quality. Musical murmurs are sometimes present and may have a honking quality. Frequently the murmur radiates a long way dorsally from the left apex, and may even appear to have a PMI over the base of the heart. This may be because of the vibration of the left atrial wall in association with the regurgitant jet of blood.