Mitral valve prolapse physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Classic finding on cardiac exam is a late holosystolic murmur with a mid-systolic click. MVP patients tend to have a low body mass index (BMI) and are typically leaner than individuals without MVP. They may also have skeletal abnormalities possibly indicating the presence of a syndrome such as marfans syndrome.

Physical Examination

Appearance

Skeletal deformities which may be found in patients with MVP are:

Heart

Auscultation

Heart Sounds
  • A mid-to-late systolic click is present, followed by a late systolic murmur which is best heard at the cardiac apex.
  • Click is early in systole, if patient is standing, sitting or valsalva maneuver.[1]
  • Click is late in systole, if patient is squatting or leg raising.[1]

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Murmurs
  • Late systolic murmur is present early in the course of disease.
  • A holosystolic murmur may be present if severe prolapse occurs.
  • Best heard:
  • Complete precordial area, if regurgitent blood is directed anteriorly.
  • Back and left axilla, if regurgitant blood is directed posteriorly.
  • Murmur is prolonged, if patient is standing, sitting or valsalva maneuver.[1]
  • Murmur is shortened, if patient is squatting or leg raising.[1]

References

  1. 1.0 1.1 1.2 1.3 Devereux RB, Kramer-Fox R, Kligfield P (1989). "Mitral valve prolapse: causes, clinical manifestations, and management". Ann Intern Med. 111 (4): 305–17. PMID 2667419.


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