In the process of evaluating an increasing number of people presenting with a midsystolic click and/or late systolic murmur, it became apparent that two distinct groups could be identified: Group 1 consists of patients who were referred for some other reason, are totally asymptomatic, have a mid-systolic click and/or a late systolic murmur on auscultation, and exhibit a typical ballooning posterior leaflet on echocardiography not due to any demonstrable organic heart disease. This group appears to be quite common. A second group of patients, presenting not only with the midsystolic click and/or late systolic murmur and a positive echocardiogram for ballooning posterior leaflet but also with overt symptomatology, are considered to have the ballooning posterior leaflet syndrome.
The inordinate emotional lability and many vague symptoms (chest pain, fatigue, palpitations) in patients with the complete syndrome was impressive. Indeed, symptoms of “neuropsychiatric origin” appeared to play a role in many of those patients described by Hancock and Jeresaty. In addition, the observation that emotional lability contributed to the sudden death of two patients with the ballooning posterior leaflet syndrome raised the question as to whether objective assessment of personality features might help to identify patients with the full syndrome particularly at risk for sudden death. A standardized personality test, the Minnesota Multiphasic Personality Inventory (MMPI), was, therefore, given to both groups of patients in an effort to more objectively assess the presence of gross psychopathology.
Methods and Procedures
Fourteen patients, 2 men and 12 women, seen over a six-month period and exhibiting a midsystolic click and/or late systolic murmur, were studied. In all cases, the click and murmur moved in the manner expected for the ballooning posterior leaflet. A clearly positive echocardiogram for ballooning of the posterior mitral leaflet was used to confirm the diagnosis in all cases. An MMPI was administered to all patients. The MMPI is a standardized questionnaire consisting of 566 statements to which a subject answers “true” or “false.” These responses are combined to yield scores on four validity scales and ten clinical scales: hypochondriasis, depression, hysteria, psychopathic deviate, masculinity-femimn-ity, paranoia, psychasthenia, schizophrenia, hypomania and social inversion. An MMPI score of 70 or higher was considered abnormal.
Four patients with symptomatic valvular aortic stenosis, observed over an eight-month period, were also evaluated with MMPIs in an effort to assess whether the presence of life-threatening symptoms per se would cause abnormal MMPI scores.