Mitral valve prolapse

Case history

A 45-year-old man presents for a routine physical exam as part of an insurance medical assessment. He is asymptomatic and has no family history of cardiac disease or sudden cardiac death. On examination, he is of slim build. Blood pressure is 115/65 mmHg, and heart rate 60 beats per minute and regular. On cardiac exam, apex beat is of normal character and nondisplaced. On auscultation, he has a midsystolic click followed by a late-systolic high-pitched murmur. On standing and with Valsalva maneuver, the click and murmur occur earlier in systole and the murmur is of increased intensity. On squatting, the click and murmur occur later in systole and the murmur is softer in intensity. There are no clinical signs of heart failure.