Mitral valve prolapse physical examination

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

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.

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

• Narrow anteroposterior chest diameter
• Scoliosis or kyphosis
• Pectus excavatum
• Hypermobility of the joints
• Arm span greater than height

• 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]

• First heart sound, S1 is normal as initial closure of mitral valve cusps is unimpeded.
• In presence of pulmonary hypertension, pulmonic component of second heart sound (P2) is loud.

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• 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 regurgitant 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]

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