Summary:

Because of the patient's concern, an echo study was performed that showed no evidence of mitral valve abnormality.

Click to review auscultation.

Lessons:

1. Splitting of S₁ is normal and must not be confused with the systolic click of mitral valve prolapse.
   
   
2. Splitting of S₁ is almost universal in the tricuspid area but is also often present at the apex in perfectly normal people.
   
   
3. When in doubt have the patient squat.
   a. A split S1 does not change.
   b. A systolic click due to MVP moves later in systole and becomes more mid-systolic in cadence.
   
   
4. Review Case 4 on how to differentiate a split S₁ from an S₄.

 

Case 17 is now finished.