Early mitral valve insufficiency is difficult to detect because of the low regurgitant flow and the lack of obvious symptoms, and therefore requires regular physical examination with echocardiographic adjuncts to detect it. Colour Doppler flow imaging has a sensitivity of up to 100% and therefore needs to be performed at least once a year. Additional laboratory tests should also be performed in priority groups such as those with a previous history of rheumatic disease, heart attack or family history of hypertrophic cardiomyopathy.