A patient presents with fatigue, anxiety, and palpitations; exam reveals a midsystolic click. What is the most likely diagnosis?

A patient presents with fatigue, anxiety, and palpitations; exam reveals a midsystolic click. What is the most likely diagnosis?

• A. Aortic stenosis
• B. Mitral valve prolapse
• C. Pulmonary embolism
• D. Hypertrophic cardiomyopathy

Answer: (B)

Midsystolic click is most characteristic of mitral valve prolapse, due to the mitral valve leaflets billowing back into the left atrium during systole when the chordae tendineae suddenly tense. This leaflet prolapse often produces a late systolic murmur that can be augmented by maneuvers that reduce venous return, but the defining click points you to MVP. Fatigue, anxiety, and palpitations can accompany MVP because of associated autonomic symptoms or intermittent arrhythmias, even though many people with MVP are asymptomatic. The other conditions don’t fit the auscultation finding: aortic stenosis typically presents with a harsh systolic murmur rather than a midsystolic click; pulmonary embolism causes acute chest symptoms and doesn’t produce a midsystolic click; hypertrophic cardiomyopathy has a dynamic systolic murmur from left ventricular outflow tract obstruction that changes with maneuvers, not a classic click. Diagnosis is usually confirmed with echocardiography, and management is often conservative, with treatment focused on symptoms (for example, beta-blockers for palpitations or anxiety) and reassurance, since MVP is commonly benign.

Midsystolic click is most characteristic of mitral valve prolapse, due to the mitral valve leaflets billowing back into the left atrium during systole when the chordae tendineae suddenly tense. This leaflet prolapse often produces a late systolic murmur that can be augmented by maneuvers that reduce venous return, but the defining click points you to MVP.

Fatigue, anxiety, and palpitations can accompany MVP because of associated autonomic symptoms or intermittent arrhythmias, even though many people with MVP are asymptomatic. The other conditions don’t fit the auscultation finding: aortic stenosis typically presents with a harsh systolic murmur rather than a midsystolic click; pulmonary embolism causes acute chest symptoms and doesn’t produce a midsystolic click; hypertrophic cardiomyopathy has a dynamic systolic murmur from left ventricular outflow tract obstruction that changes with maneuvers, not a classic click.

Diagnosis is usually confirmed with echocardiography, and management is often conservative, with treatment focused on symptoms (for example, beta-blockers for palpitations or anxiety) and reassurance, since MVP is commonly benign.