Family Nurse Practitioner Exam

What does a Grade III/VI systolic murmur with an ejection click suggest in a patient with mitral valve prolapse?

1. Normal heart function

2. Severe aortic stenosis

3. Possible valvular heart disease

4. Hypertension

The correct answer is: Possible valvular heart disease

A Grade III/VI systolic murmur with an ejection click in a patient with mitral valve prolapse strongly suggests possible valvular heart disease. In the context of mitral valve prolapse, the presence of an ejection click indicates that there is effectively a mechanical abnormality with the mitral valve apparatus. The ejection click occurs early in the systole when the mitral valve is prolapsing, which leads to turbulent blood flow and the associated murmur. The murmur's grading—being graded III—indicates a moderate intensity, which supports the notion that the mitral valve is experiencing significant regurgitation or obstruction due to the prolapse. In healthy individuals, the expected heart sounds would generally be more benign, and the presence of both a systolic murmur and an ejection click points towards a pathological condition—specifically valvular heart disease related to the mitral valve. Normal heart function would not typically present with such a murmur or an ejection click, and while severe aortic stenosis does present with murmurs, the context and specific characteristics of the sounds heard are indicative of issues predominantly involving the mitral valve in this scenario. Additionally, hypertension does not inherently produce these types of murm