Midsystolic Clicks and Coronary Heart Disease

Abstract

To the Editor: The consistent finding in all of my 18 patients with arteriographically documented coronary artery disease is a late systolic murmur. Only nine of the 18 have a late systolic click.1Cheng TO Late systolic murmur in coronary artery disease.Chest. 1972; 61: 346-356Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar Therefore, my emphasis has been on the late systolic murmur rather than on the late systolic click. However, a late systolic click was present in one of my four autopsied cases; the mitral valve leaflets appeared normal on both macroscopic and microscopic examinations in all four. That a late systolic click may accompany papillary muscle dysfunction either transiently or permanently has been reported before.2Cheng TO Some new observations on the syndrome of papillary muscle dysfunction.Am J Med. 1969; 47: 924-945Abstract Full Text PDF PubMed Scopus (60) Google Scholar, 3Cheng TO Incidence of ventricular aneurysm in coronary artery disease.An angiographic appraisal. Am J Med. 1971; 50: 340-355Scopus (69) Google Scholar, 4aSteelman RB White RS Hill JC Midsystolic clicks in atherosclerotic heart disease.Circulation. 1971; 44: 503-515Crossref PubMed Scopus (44) Google Scholar, 4bSteelman RB Midsystolic clicks in arteriosclerotic heart disease.Circulation. 1972; 45: 1146Crossref Google Scholar Furthermore, I recently encountered three new patients who developed late systolic clicks de novo during the course of their acute myocardial infarction. Presence of significant coronary artery disease was confirmed in 12 of my 18 patients by selective coronary arteriography and in the remaining six by fluoroscopic visualization of calcification of the major coronary artery branches. None of them was known to have a heart murmur in the past. That the association of coronary artery disease and the syndrome of late systolic murmur and click in my patients could hardly be a mere coincidence was further supported by the observations that selective coronary arteriography in four patients of comparable age group with the latter syndrome but no clinical evidence of coronary artery disease revealed no significant coronary artery disease. The syndrome of papillary muscle dysfunction may or may not be associated with generalized or localized akinesis.2Cheng TO Some new observations on the syndrome of papillary muscle dysfunction.Am J Med. 1969; 47: 924-945Abstract Full Text PDF PubMed Scopus (60) Google Scholar Therefore, good ventricular contractility is entirely compatible with, and not an “unexpected finding” in, papillary muscle dysfunction. Lastly, since Dr. Jeresaty's article appeared in the July, 1971 issue of Radiology,5Jeresaty RM Ballooning of the mitral valve leaflets: angiographic study of 24 patients.Radiology. 1971; 100: 45-52Crossref PubMed Scopus (22) Google Scholar and my manuscript was submitted to Chest in February, 1971, it could not have been included in my bibliography. Midsystolic Clicks and Coronary Heart DiseaseCHESTVol. 63Issue 2PreviewTo the Editor: Full-Text PDF