a u s c u l t a t i o n    t u t o r
Mid Systolic Click


This click is heard at the apex in mid or late systole; it may be intermittent. It is unchanged by respiration,
but can be delayed or abolished with increased LV cavity dimension following a squat from standing or
raising the legs of a supine patient. The click may first become apparent or, if already audible, will move
toward the S1 as the LV cavity dimension decreases with standing or a Valsalva. It is sometimes
associated with a late systolic murmur of mitral insufficiency. Most individuals are otherwise normal,
although mitral prolapse occurs with increased frequency in Marfan syndrome and myxomatous mitral
valve changes.
t h e     h e a r t
Normal Cardiac Cycle
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