Snapshot A 40-year-old woman presents to the emergency department complaining that she can feel her heart beating. She occasionally experiences difficulty breathing following exercise and reports an intermittent cough. Her echocardiogram is shown in the figure. Introduction Definition redundant valve tissue results in bulging of one or both leaflets into left atrium during systole may be a result of excess production of valve substance (dermatan sulfate) may be a result of myxomatous degeneration may have concomitant regurgitation risk of chorda tendinae rupture Epidemiology more frequently in younger women tends to be familial up to 10% of the population having some degree of MVP usually an isolated abnormality but may be associated with Marfan's/Ehlers-Danlos syndrome atrial septal defect Presentation Symptoms most patients are asymptomatic when symptomatic, patients may present with a range of symptoms including palpitations chest pain (not associated with CAD or MI) exertional dyspnea fatigue cough orthopnea MVP rarely presents in a form of panic disorder Physical exam cardiac auscultation demonstrates mid-systolic click due to sudden tensing of chorda tendinae ↓ preload moves click closer to S1 late systolic murmur may follow click if regurgitation is present may find palpable thrill over the chest wall