A 20 year old female patient has non exeional chest pain. On auscultation, she had multiple non-ejection clicks. Investigation of choice would be: September 2008

Ans. D: Echocardiography Ejection clicks/ ejection sounds are high-pitched sounds that occur at the moment of maximal opening of the aoic or pulmonary valves. They are heard just after the first hea sound. The sounds occur in the presence of a dilated aoa or pulmonary aery or in the presence of a bicuspid or flexible stenotic aoic or pulmonary valve. The diastolic correlate of the ejection click is the opening snap, which occurs at maximal opening of a flexibly stenotic mitral or tricuspid valve. Non ejection clicks/ midsystolic clicks occurring with or without a late systolic murmur (crescendo-decrescendo), often denotes prolapse of one/both leaflets of the mitral valve.They are best heard along the lower left sternal border and at the left ventricular apex. ECG is normal commonly in MVP, but may show biphasic/ inveed T waves inleads II, III and aVF. Echocardiography is paicularly effective in identifying the abnormal position and prolapse of the mitral valve leaflets.