What Does a Heart Valve "Squeak" Mean?
A "squeak" from a heart valve most likely represents a musical or honking quality murmur associated with mitral valve prolapse (MVP), which occurs when the mitral valve leaflets suddenly tense as they prolapse into the left atrium during systole. 1
Understanding the Sound
The "squeak" you're hearing is most consistent with the characteristic sounds of MVP:
- The midsystolic click is a high-pitched sound of short duration that results from sudden tensing of the mitral valve apparatus as the leaflets prolapse into the left atrium during systole 1
- The murmur may have a musical or honking quality that varies considerably in intensity and timing, from brief and almost inaudible to holosystolic and loud 1
- These sounds are intermittent and variable, which explains why you only hear it on rare occasions 1
Why the Sound Changes
The click and murmur characteristics vary based on your heart's loading conditions:
- Standing decreases left ventricular volume, causing MVP to occur earlier in systole and making the click-murmur complex more prominent 1
- Squatting or lying down increases ventricular volume, which lengthens the time to MVP occurrence and may make the sound softer or disappear 1
- The Valsalva maneuver (bearing down) typically makes the MVP murmur longer and often louder 1
Clinical Significance
Most patients with MVP have a benign prognosis with annual mortality rates less than 1% per year. 1
However, you should seek evaluation if you experience:
- Palpitations, chest pain, or shortness of breath - these symptoms warrant further workup even in asymptomatic MVP 1
- Syncope or near-syncope - this requires more aggressive evaluation 1
- Any new or worsening symptoms - changes in clinical status necessitate reassessment 1
Recommended Evaluation
Echocardiography is indicated for diagnosis of MVP and assessment of mitral regurgitation, leaflet morphology, and ventricular compensation when physical signs of MVP are present. 1
The physical examination findings to look for include:
- The midsystolic click - the principal auscultatory feature 1
- Late systolic murmur - usually medium-to-high pitched, loudest at the cardiac apex 1
- Dynamic changes with position - the click-murmur complex moves with standing versus squatting 1
Important Caveats
- Not all "squeaks" are MVP - other causes of musical murmurs exist, though MVP is most common 1
- MVP can be present without classic auscultatory findings - the clicks may be intermittent and variable 1
- Reassurance is a major part of management - patients with mild or no symptoms and milder forms of prolapse should be reassured of the benign prognosis 1
- A normal lifestyle and regular exercise is encouraged for most patients with MVP 1