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Heart Sounds Research Lab
Mid-Systolic Click (MVP)
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A common error that can occur is erroneous timing of a mid systolic click. Such a sound is present in patients with mitral valve prolapse. When the mid systolic click occurs in the latter part of systole, it may simulate two events around S2. When occurring late in systole, the click may be misinterpreted as S2, and the true second heart sound (S2) interpreted as an early diastolic sound. This can be avoided by listening carefully in many areas of the precordium for the normal physiologic splitting of S2, in particular listening at the second and third left intercostal spaces. By such auscultation of the second heart sound, one can appreciate that the mid systolic click is a systolic sound and precedes S2.
The mid systolic click is best heard with the diaphragm of the stethoscope. Timing of the click can be manipulated by maneuvers such as handgrip, valsalva, and standing/squatting.
Mid-Systlic Click (MVP)