A 28-year-old woman with mitral valve prolapse presents for evaluation. On dynamic auscultation, which manoeuvre produces a characteristic delay in the mid-systolic click and lengthening of the late systolic murmur in this condition?

• A Squatting
• B Handgrip
• C Leg elevation
• D Valsalva manoeuvre (strain phase) ✓

Explanation

In mitral valve prolapse, decreased preload (Valsalva strain phase, standing) causes the click and murmur to move earlier in systole and lengthen. Conversely, increased preload (squatting, leg elevation) or increased afterload (handgrip) delays the click and shortens the murmur. The Valsalva manoeuvre reduces venous return, decreasing LV volume and allowing the valve to prolapse earlier.

Reference: Braunwald's Heart Disease, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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