The Syndrome Associated with Mid-systolic Click and/or Late Systolic Murmur

Analysis of 32 cases

¹ Director, Section of Cardiology, St. Francis Hospital, Hartford, Connecticut. Assistant Professor of Medicine and Consultant in Cardiology, University of Connecticut School of Medicine

We have collected 32 patients with the syndrome associated with mid-systolic click and/or late systolic murmur attesting to its prevalence. Ballooning of the posterior leaflet of the mitral valve was visualized in the 11 patients who underwent left ventriculography. Chest pain occurred in 20 of our 32 patients, dyspnea in 16, fatigue in 15, palpitations in 13, and lightheadedness in 9. The clinical pattern was often atypical. A midsystolic click followed by a late systolic murmur was recorded in 18 patients and in eight only a click was observed. In one patient with neither click nor murmur, mitral ballooning associated with chest pain and T wave changes was silent. In five patients with proved ballooning only a pansystolic murmur was heard. In 22 patients, we noted T wave inversion in lead aVF. Cardiac catheterization showed a "constrictive pattern" in five patients. Selective cine coronary arteriography performed in five patients was normal.

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