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