Late systolic murmurs and non-ejection ("mid-late") systolic clicks. An analysis of 90 patients.

Abstract

Evidence has previously been produced from this laboratory (Barlow and Pocock, 1963;Barlow, 1965) that apical late systolic murmurs denote mitral regurgitation, and that the commonly associated non-ejection systolic clicks also have an intracardiac, and probably chordal, origin. It has also been suggested that the association of these auscultatory features with a distinctive electrocardiographic pattern and a billowing posterior leaflet of the mitral valve constitutes a specific syndrome (Barlow, 1965;Barlow and Bosman, 1966).In this paper we present an analysis of 90 subjects with either a late systolic murmur, a nonejection click, or both. The intracardiac origin of these murmurs and clicks is reaffirmed and their possible mode of production is considered. The abnormal electrocardiogram, the probable structural abnormality of the mitral valve mechanism, the various underlying aetiological factors, and the prognosis are discussed. SUBJECTS AND METHODSOf the 90 subjects, 65 were referred to the Cardiac Clinic for assessment of their auscultatory signs. Seven were found during hospital admission for a non-cardiac illness; 6 were detected after closed mitral valvotomy, and 5 others after other forms of mitral valve surgery. One 30-year-old woman complaining of palpitations, who regularly attended the Clinic, developed a late systolic murmur and click a year after observation began. Examination of relatives of patients with late systolic murmurs or non-ejection clicks produced a further 6 cases.The 90 subjects ranged in age from 4 to 63 years; 45 of them, including 13 children, were under the age of 30;

Primary mitral valve regurgitation: Update and review

“…The leaflets and the chordae appear thickened, redundant and elongated. Multiple scallops of both anterior and posterior leaflets prolapse or may flail into the left atrium during systole 15,16 (Movie 2). Of note, these 2 forms of mitral valve prolapse represent the two ends of a spectrum.…”

Hemiplegia and the billowing mitral leaflet syndrome.

“…The incidence of prolapsing mitral valve is said to be 0.5% of the male, and 6% of the female population (Brown et al, 1975;Procacci et al, 1976). The cardiovascular manifestations have been well documented (Barlow et al, 1963(Barlow et al, , 1968Hancock and Cohn, 1966;Barlow and Pocock, 1975;O'Rourke et al, 1975 …”

An interpretation - mitral valve prolapse syndrome

“…Late potentials may exist 24,25 . The literature also reports cases of sudden death 19,26,27 . These clinical manifestations associated with prolapse constitute MVP syndrome.…”

“…Patients may have complaints of atypical chest pain and palpitations. The electrocardiogram may show ventricular repolarization alterations, especially in the inferior derivatives (leads) 19 . Patients might have arrhythmias 20,21 , stretching of the QT segment and its greater dispersion (spread) 22,23 .…”

“…Hypotheses have been thought of, for example the exaggerated traction of the leaflets over the papillary muscles could cause ischemia and pain 17 ; the increased tension of the leaflet could deform, the atrioventricular groove affecting the circumflex artery and producing ischemia 19 . Nervous terminals in the overly tensioned leaflets could result in arrhythmia 3,17 .…”