Prolapsed Valve Auscultatory Findings Shape and Loudness of Click and Murmur

1. What is the usual shape of delayed systolic murmurs in prolapsed mitral valve syndrome?

ANS: To the ear, they often sound crescendo to the second sound.

The midsystolic sound was a click heard loudest at the apex in this 45-year-old woman. The murmur following it is crescendo to the S2. This is the classic ballooned valve click-murmur complex by auscultation.

2. What peculiar kind of murmur quality is almost pathognomonic of a prolapsed mitral valve?

ANS: Systolic musical honks or whoops are not an uncommon sign of a prolapsed valve. They are usually transient and disappear with different phases of respiration. When they have disappeared, a regurgitant murmur is almost always present. (The word honk refers to the similarity of this sound to the honking of a goose.) These musical honks or whoops are the loudest murmurs heard in cardiologic practice. Many of these patients can hear their own murmurs, and some murmurs can even be heard across the room.

Note: Musical MR murmurs or honks are due to vibrations of the valves themselves [6]. The usual murmur is caused by turbulence around the valve rather than by the vibrations themselves.

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