Mitral valve prolapse physical examination

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

Overview

MVP patients tend to have a low body mass index (BMI) and are typically leaner than individuals without MVP. They also have few skeletal abnormalities indicating any associated syndrome e.g. marfan 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.
• Click is late in systole, if patient is squatting or leg raising.
• 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 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.
• Murmur is shortened, if patient is squatting or leg raising.

References

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