Palpitations and Late Systolic Murmur in a Young Man

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 1892¹and again by Reid²in 1961. Five years later, Barlow and Bosman angiographically demonstrated mitral prolapse.³Echocardiographic findings were described by Shah and Gramiak⁴in 1970 and by Dillon et al⁵and Kerber et al⁶in 1971. Careful physical examination has disclosed typical findings of mitral prolapse in 6%⁷to 17%⁸of presumably healthy young women. There often are associated skeletal deformities, such as pectus