Our Patient

Let us summarize our patient's history and physical examination. She is a 30 yo woman with fleeting, non-exertional, sharp chest pains and palpitations. This is not enough to make a specific diagnosis. Her age and lack of risk factors argue against coronary artery disease and the chest pains do not suggest angina. The palpitations are probably from premature beats and can be found in many disorders.

On physical examination, she appeared anxious, with a thin habitus. Again, non-specific findings. Her lungs were clear on auscultation, and her blood pressure, arterial and venous pulses and precordial examination were all normal, suggesting the absence of severe cardiac pathology. Upon auscultation of her heart, the first and second heart sounds were normal and no gallops were noted. At the left sternal border and apex early systole was silent. In mid systole there were two high-frequency clicks followed by a mid-late systolic crescendo high-frequency systolic murmur that ended with S2. Upon standing, with the decrease in venous return, the clicks and murmur moved closer to S1 and the murmur was longer. Upon squatting, with an increase in venous return and afterload, the opposite findings occurred.

Putting our history and physical together, the diagnosis is mitral valve prolapse, or MVP, with only mild-to-moderate mitral regurgitation. Since she has no specific findings suggesting connective tissue disorders such as Marfan's or Ehlers Danlos syndromes, it is presumed she has primary mitral valve prolapse related to myxomatous degeneration of her valve leaflets and chordae tendineae.