Floppy-valve syndrome, Barlow’s syndrome Excessive connective tissue in the mitral leaflet  elongating and thickening the valve Displacement of the mitral valve into the LA during systole

 Females > males  More common among years old  Body features that could be associated with MVP: ▪ Asthenic body habitus ▪ Low body weight or body mass index (BMI) ▪ Straight-back syndrome ▪ Scoliosis or kyphosis ▪ Pectus excavatum ▪ Hypermobility of the joints ▪ Arm span greater than height (which may be indicative of Marfan syndrome)

Midsystolic Click  Classic auscultatory feature of MVP  Elongated leaflet balloons into the left atrium during systole leaflet collapses into the atrium, producing a click  Or produced by sudden tensing of slack, elongated chordae tendinae

Midsystolic Click

 Midsystolic click may be followed by a high- pitched mid- to late systolic murmur  Crescendo-decrescendo, often heard best at the apex  Prolapse of the mitral valve causes some regurgitation of blood into the left atrium

 Occurrence of click and murmur vary according to position  In general, any maneuver that decreases the end- diastolic LV volume, increases the rate of ventricular contraction or decreases resistance to the LV ejection of blood causes MVP to occur earlier in systole (standing, valsalva maneuver)

 Anxiety  Panic attacks  Arrythmias  Exercise intolerance  Palpitations  Atypical chest pain  Fatigue  Orthostasis  Syncope or presyncope  Neuropsychiatric symptoms

 Fatigue  Dyspnea  Exercise intolerance  Orthopnea  Paroxysmal nocturnal dyspnea (PND)  Progressive signs of congestive heart failure (CHF)