Mitral Clicks and Murmurs

Abner J. Delman, Milton J. Sands, Charles B. Mullins

Research output: Contribution to journalLetterpeer-review


To the Editor: Lobstein et al. (N Engl J Med 289:127–131, 1973) accurately describe the effects that vasoactive maneuvers may have on the systolic click and murmur in patients with the mitral click-murmur syndrome. However, their statement that the murmur of rheumatic mitral regurgitation is unaltered by these maneuvers requires comment. After amyl nitrite inhalation or during the strain phase of Valsalva's maneuver, the systolic murmur of rheumatic mitral regurgitation usually is appreciably reduced in intensity and may shorten in duration. Elevating afterload with phenylephrine, squatting, or the overshoot phase of Valsalva's maneuver is frequently associated with a concomitant increase.

Original languageEnglish (US)
Pages (from-to)869
Number of pages1
JournalNew England Journal of Medicine
Issue number16
StatePublished - Oct 18 1973

ASJC Scopus subject areas

  • General Medicine


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