June 1979

Transient Ischemic Attack Associated With Mitral Systolic Clicks

Author Affiliations

From the Cardiology Graphics Laboratory, Section of Cardiology, Northwestern University School of Medicine, Chicago.

Arch Intern Med. 1979;139(6):693-694. doi:10.1001/archinte.1979.03630430069022

A 26-year-old woman was seen at Northwestern Memorial Hospital, Chicago, because of posterior occipital headache associated with right upper extremity paresis and dysarthria that lasted a period of ten minutes. Physical examination disclosed straightening of the thoracic spine and minimal pectus excavatum. Precordial examination showed midsystolic and late systolic clicks; the earlier click was followed by a soft grade 2/6 murmur. Neurological examination disclosed slight hyperreflexia on the right side.

An M-mode echocardiogram of the mitral valve, performed the day after admission, is shown below (Fig 1). What is your diagnosis?

Diagnosis.—Mitral Valve Prolapse (Barlow's Syndrome  )The patient had a normal echocardiogram, chest x-ray film, EEG, and EMI scan; results of platelet aggregation studies were also normal. A treadmill stress test was performed, which did not provoke arrhythmias. A 24-hour ambulatory ECG monitor showed slight predisposition to faster than expected resting sinus rates, but no supraventricular or ventricular arrhythmias.

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