A lady presented with dyspnea and palpitations. On examination there was a non ejection click. Next investigation is: March 2009

Ans. D: Echocardiography The presence of a nonejection click on physical examination is sufficient to make the diagnosis of mitral valve prolapse. The sound has a sharp high-frequency clicking quality and, although often confined to the bit apex, can be transmitted widely on the precordium. The cause of the sound is due to tensing of the AV valves during systole. As with other high-frequency cardiac sounds, it is produced by vibrations of the entire cardiohemic system when the elastic limits of the prolapsed valve are suddenly reached. Echocardiography is the investigation required for fuher evaluation.