213. What maneuvers can be done to alter the timing of the click in mitral valve prolapse?

Mitral valve prolapse produces a mid-systolic click usually followed by a uniform, high-pitched murmur.  The murmur is actually due to mitral regurgitation that accompanies the MVP, thus it is heard best at the cardiac apex. MVP responds to dynamic auscultation.

After sudden standing, preload is decreased and the click moves earlier in systole. With sudden squatting, preload increases and the click moves later in systole.

MVP