What is the classic auscultatory finding in mitral valve prolapse?

What is the classic auscultatory finding in mitral valve prolapse?

• A. Murmur best heard at apex in expiration
• B. Fixed splitting S2
• C. Systolic ejection murmur
• D. Mid-to-late systolic click

Answer: (D)

Mitral valve prolapse presents with a midsystolic click caused by sudden tensing and prolapse of the mitral valve leaflets into the left atrium during systole. This click is typically mid-to-late in systole and is often followed by a late systolic murmur if mitral regurgitation is present. The hallmark sound is the mid-to-late systolic click heard best at the apex with the patient in the left lateral decubitus position; maneuvers that decrease venous return (standing or Valsalva) make the click occur earlier and can accentuate the murmur, while squatting delays the click and tends to soften the murmur. Other patterns point to different conditions: a diastolic component at the apex suggests mitral stenosis, fixed S2 splitting suggests an atrial septal defect, and a systolic ejection murmur suggests outflow obstruction such as aortic stenosis.

Mitral valve prolapse presents with a midsystolic click caused by sudden tensing and prolapse of the mitral valve leaflets into the left atrium during systole. This click is typically mid-to-late in systole and is often followed by a late systolic murmur if mitral regurgitation is present. The hallmark sound is the mid-to-late systolic click heard best at the apex with the patient in the left lateral decubitus position; maneuvers that decrease venous return (standing or Valsalva) make the click occur earlier and can accentuate the murmur, while squatting delays the click and tends to soften the murmur. Other patterns point to different conditions: a diastolic component at the apex suggests mitral stenosis, fixed S2 splitting suggests an atrial septal defect, and a systolic ejection murmur suggests outflow obstruction such as aortic stenosis.