Mitral valve prolapse vs Mitral regurgitation
How to tell Mitral valve prolapse and Mitral regurgitation apart when a board question makes them look alike.
MVP is click plus late systolic murmur; MR is holosystolic apical murmur radiating to axilla.
Side by side
Midsystolic click with late systolic murmur; standing/Valsalva moves click earlier and lengthens murmur.
Holosystolic blowing murmur at apex radiating to axilla, often worse with handgrip or acute after papillary muscle dysfunction.
Redundant mitral leaflets prolapse into the left atrium after LV volume falls below a critical point during systole.
Incompetent mitral closure allows systolic LV-to-LA backflow throughout systole.
Click timing that changes with preload is the MVP anchor.
Pulmonary edema after MI with apical holosystolic axillary murmur points MR.
The trap
MVP can progress to or coexist with MR, but the auscultatory signature is the discriminator. MVP is a midsystolic click followed by a late systolic murmur at the apex; MR is a holosystolic apical murmur radiating to the axilla with no click. Maneuvers that decrease preload (Valsalva, standing) move the MVP click earlier in systole and lengthen the murmur; maneuvers that increase preload (squatting, handgrip) delay the click and shorten the murmur.
Watch it explained
The repair move
For any mitral systolic murmur, do three things in order: (1) listen for a midsystolic click before the murmur (click present means MVP); (2) test maneuvers (Valsalva and standing move the MVP click earlier; handgrip and squatting move it later); (3) characterize the murmur (holosystolic blowing radiating to axilla is MR, late systolic crescendo is MVP).
Try a free question
CoreA young patient has a midsystolic click followed by a late systolic murmur at the apex. Standing and Valsalva make the click occur earlier and lengthen the murmur. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Mitral valve prolapse. Mitral valve prolapse produces a midsystolic click and late systolic murmur; decreased LV volume makes prolapse occur earlier.
Why the other choices are tempting
- B. Mitral regurgitation is a holosystolic apical murmur radiating to the axilla.
- C. Aortic stenosis is systolic ejection at the right upper sternal border with carotid radiation.
- D. Mitral stenosis is a diastolic rumble with opening snap.
- E. Tricuspid regurgitation is holosystolic at the lower left sternal border and increases with inspiration.
Flashcards
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What is the fastest separator for Mitral valve prolapse vs Mitral regurgitation?
MVP is click plus late systolic murmur; MR is holosystolic apical murmur radiating to axilla.
What clue should make you choose Mitral valve prolapse?
Midsystolic click with late systolic murmur; standing/Valsalva moves click earlier and lengthens murmur.
Quick answers
What is the fastest way to tell Mitral valve prolapse from Mitral regurgitation?
MVP is click plus late systolic murmur; MR is holosystolic apical murmur radiating to axilla.
What is the key clue for Mitral valve prolapse?
Midsystolic click with late systolic murmur; standing/Valsalva moves click earlier and lengthens murmur.
What is the key clue for Mitral regurgitation?
Holosystolic blowing murmur at apex radiating to axilla, often worse with handgrip or acute after papillary muscle dysfunction.
What is the common trap with Mitral valve prolapse vs Mitral regurgitation?
MVP can progress to or coexist with MR, but the auscultatory signature is the discriminator. MVP is a midsystolic click followed by a late systolic murmur at the apex; MR is a holosystolic apical murmur radiating to the axilla with no click. Maneuvers that decrease preload (Valsalva, standing) move the MVP click earlier in systole and lengthen the murmur; maneuvers that increase preload (squatting, handgrip) delay the click and shorten the murmur.