The isolated systolic click with bacterial endocarditis

Abstract

The mitral valve and its supporting structures have been convincingly implicated as a source of late systolic murmurs as well as mid to late systolic (nonejection) clicks. Although attention has been called to theoretical susceptibility to endocarditis in subjects with these auscultatory signs, the patient whose case is described here represents the first example of the occurrence of endocarditis in this context. The endocarditis had its inception when only an isolated systolic click was heard. A late systolic murmur appeared for the first time during the course of treatment. In view of the difficulty in distinguishing intracardiac from extracardiac systolic clicks, consideration must be given to prophylaxis for endocarditis even when these mid to late systolic clicking sounds occur without an accompanying late systolic murmur.