A 24-year-old woman has an incidental mid-systolic click followed by a late systolic murmur at the apex. Which manoeuvre will make both the click and the murmur occur EARLIER in systole?

• A Squatting
• B Isometric handgrip
• C Standing from supine position ✓
• D Passive leg raising

Explanation

In mitral valve prolapse, any manoeuvre that reduces left ventricular volume (standing, Valsalva strain, amyl nitrite) brings the prolapsing leaflets to the coaptation point earlier, so the click and murmur move toward S1. Squatting, handgrip, and leg raising increase preload or afterload, enlarge the LV cavity, and delay the click and murmur toward S2. This dynamic behaviour distinguishes MVP from fixed murmurs such as mitral regurgitation.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.