Intensive Care Medicine (ICM) Practice Exam

A 20-year old female patient, arrived for a routine yearly physical, is found to have a mid-systolic click during a cardiac exam. She has not complained of any headaches, palpitations or other associated symptoms. This finding is:

1. Normal

2. Abnormal but common

3. Abnormal and uncommon

4. Immediately life threatening

The correct answer is: Normal

The presence of a mid-systolic click in a young female patient, especially in the context of an otherwise normal examination and absence of symptoms, is often considered a normal variant. Mid-systolic clicks are frequently associated with mitral valve prolapse, a condition that may be common in the general population and particularly in young women. In asymptomatic patients, this finding can be benign, and many individuals with a mid-systolic click do not experience any related health problems. While a mid-systolic click can indicate underlying anatomical changes in the heart, in the absence of concerning symptoms such as palpitations, chest pain, or signs of heart failure, it is usually not viewed as a significant clinical finding. Thus, it is categorized as a normal occurrence, particularly in a young, healthy individual. In contrast, classifying this finding as abnormal and uncommon would suggest a level of severity not indicated by the patient's presentation, while defining it as immediately life-threatening would be an inaccurate assessment of risk in a young, asymptomatic person.