the apex even without vasoactive maneuvers. On follow-up clinic visits two weeks and three months after discharge, the patient felt quite well, and auscultation of the heart revealed prominent late systolic click but no murmur. However, a late systolic murmur could again be precipitated by isometric exercise. DIscussIoN Until the past few years, a late systolic murmur at the apex, preceded by a...

The effects of passive head-up tilt on systolic time intervals were assessed in 18 patients with mitral valve prolapse. In addition to causing prolongation of the pre-ejection period and shortening of left ventricular ejection time, this circulatory stress led to progressive shortening of the Q to click interval. In 1 patient, a systolic click became audible which had not been heard in the supi...

The onset of mitral valve prolapse and its close correlate, the time of systolic click, vary considerably with different physiologic and pharmacologic interventions. In order to explain the mechanism responsible for these alterations, the effects of tilt and amyl nitrite inhalation on left ventricular dynamics and the time of the systolic click were studied by analyzing echocardiograms and simu...

A contraction abnormality of the left ventricle has previously been described in patients with systolic click-late systolic murmur syndrome. To determine if the contraction abnormality is present in the preprolapse period, LV dimensions and the instantaneous velocity of circumferential fiber shortening (VCF) were studied in 18 patients with the mitral valve prolapse and 16 normal subjects using...

Two patients with seriously impaired left ventricular function, abnormal left ventricular conduction on the electrocardiogram, mitral regurgitation, and a very late systolic click are reported. Idiopathic non-obstructive cardiomyopathy seemed to be the cause of the left ventricular dysfunction in both cases. The mitral valve was anatomically normal at the time of operation in one patient, excep...

Patients with late systolic murmurs, with and without mid-late systolic extra sounds, have recently been shown to have mitral regurgitation. This syndrome has been found to be familial in each of the four families we have studied. These families were found to have a high prevalence of mid-late systolic extra sounds, late systolic murmurs, pansystolic murmurs, abnormal electrocardiograms, and un...