A 25-year-old man was seen because of palpitations. Physical examination disclosed a slender man with a crescendo late systolic apical murmur. The ECG was normal, except for occasional premature ventricular beats. His echocardiogram and a superimposed apex phonocardiogram are shown in the Figure below.
What is your diagnosis?
Diagnosis.—Mitral Valve Prolapse
Sharp midsystolic sounds that Gallavardin (1913) believed were due to pleuropericardial adhesions were recognized as originating in the mitral apparatus by Griffith in 18921 and again by Reid2 in 1961. Five years later, Barlow and Bosman angiographically demonstrated mitral prolapse.3 Echocardiographic findings were described by Shah and Gramiak4 in 1970 and by Dillon et al5 and Kerber et al6 in 1971. Careful physical examination has disclosed typical findings of mitral prolapse in 6%7 to 17%8 of presumably healthy young women. There often are associated skeletal deformities, such as pectus