The Apexcardiogram in Patients with Systolic Prolapse of the Mitral Valve

¹ Department of Adult Cardiology, Division of Medicine, Cook County Hospital; the Department of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, Chicago
² Director, Department of Adult Cardiology, Cook County Hospital; Associate Professor of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, Chicago
³ Associate Director, Department of Adult Cardiology, Cook County Hospital; Associate Professor of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, Chicago
⁴ Director, Intensive Coronary Care Unit, Cook County Hospital; Assistant Professor of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, Chicago
⁵ Director, Division of Medicine, Cook County Hospital; Edmund F. Foley Professor of Medicine, Abraham Lincoln School of Medicine, University of Illinois College of Medicine

Fifteen patients with the clinical and phonocardiographic finding of a nonejection click initiating a late systolic murmur had apexcardiograms (ACG) performed. In every case, the inward motion of the apex normally inscribed between aortic valve opening and closure was interrupted by either a notch or a second systolic wave, the onset of which occurred at the time of the click. This ACG finding was associated with a double apical systolic impulse in some patients. Therefore, systolic prolapse of the mitral valve has to be excluded from other conditions that cause a double apical impulse.