From the Guidelines
Hearing a click with your heart sounds is most likely indicative of mitral valve prolapse (MVP), a condition where the mitral valve doesn't close properly, and it should be evaluated by a healthcare provider. This condition is characterized by a midsystolic click, a high-pitched sound of short duration, which may be followed by a late systolic murmur 1. The primary diagnostic evaluation of MVP is the physical examination, focusing on auscultatory features such as the timing and intensity of the click and murmur, which can vary with left ventricular loading conditions and contractility.
The presence of a click can be an important diagnostic clue, as it results from the sudden tensing of the mitral valve apparatus as the leaflets prolapse into the left atrium during systole 1. Dynamic auscultation, where the patient's position or maneuvers are changed to alter left ventricular volume, can help establish the diagnosis by demonstrating changes in the timing of the click and murmur. For instance, standing decreases left ventricular end-diastolic volume, causing the click-murmur complex to occur sooner after the first heart sound, while squatting has the opposite effect 1.
While the electrocardiogram (ECG) may show nonspecific changes, it is often normal in patients with MVP 1. Two-dimensional and Doppler echocardiography is the most useful noninvasive test for defining MVP, looking for valve prolapse of 2 mm or more above the mitral annulus, leaflet coaptation on the atrial side of the annular plane, and leaflet thickness 1. The absence or presence of mitral regurgitation (MR) is also an important consideration, with MVP more likely when MR is detected as a high-velocity eccentric jet in late systole 1.
Key points to consider include:
- The click associated with MVP can be intermittent and variable.
- MVP can be present without classic auscultatory findings.
- Echocardiography is indicated for the diagnosis of MVP and assessment of MR, leaflet morphology, and ventricular compensation in asymptomatic patients with physical signs of MVP 1.
- Reassurance is a major part of the management of patients with MVP, with a normal lifestyle and regular exercise encouraged for those with mild or no symptoms 1.
If you notice a new heart click, especially if accompanied by symptoms like shortness of breath, chest pain, dizziness, or palpitations, seek medical attention promptly for a thorough evaluation and appropriate management.
From the Research
Hearing a Click with Heart Sounds
- A clicking sound heard with heart sounds can be a sign of various cardiac conditions, including mitral valve prolapse 2, 3.
- This sound is often described as a short, high-pitched "snap" or "click" and can be a frequent finding in both symptomatic and asymptomatic patients with heart disease 2.
- The presence of a click can indicate structural changes in the valves, which may or may not be of hemodynamic significance, but can increase the risk of infective endocarditis 2.
Possible Causes
- Mitral valve prolapse is a common cause of a midsystolic click, which can be accompanied by a late systolic murmur 3.
- Other cardiac diseases, such as myxomatous degeneration of the mitral valve leaflet, can also cause mitral valve prolapse and regurgitation associated with a midsystolic click 3.
- A clicking sound can also be a sign of a left-sided pneumothorax or pneumomediastinum, known as Hamman's sign 4, 5.
Diagnosis and Management
- The diagnosis of mitral valve prolapse can be confirmed by echocardiography, which demonstrates the abnormally prolapsed mitral valve leaflet 3.
- Patients with mitral valve prolapse should receive antibiotic prophylaxis prior to any surgical or dental procedures to prevent infective endocarditis 2, 3.
- In cases where a clicking sound is suspected to be caused by a left-sided pneumothorax or pneumomediastinum, imaging studies such as chest radiograph and computed tomography scan can be used to confirm the diagnosis 4, 5.