- Exercise stress testing unmasked frequent premature ventricular contractions and a midlate systolic apical click that were absent at rest.
- Transthoracic echocardiography confirmed Barlow syndrome with a 7 mm mitral annular disjunction.
- Beta-blocker therapy improved symptoms, highlighting the diagnostic and therapeutic value of stress testing in occult mitral valve disease.
JACC Case Rep. 2026 Sep 23:110384. doi: 10.1016/j.jaccas.2026.110384. Online ahead of print.
ABSTRACT
BACKGROUND: Barlow syndrome, a form of myxomatous mitral valve prolapse, often presents with nonspecific symptoms and may be missed on resting examination.
CASE SUMMARY: A 38-year-old woman presented with recurrent palpitations triggered by stress and poor sleep. Resting physical examination was unremarkable. Exercise stress test (EST) revealed frequent premature ventricular contractions and a midlate systolic apical click postexercise, which were both previously absent at rest. Echocardiography confirmed Barlow syndrome with 7 mm mitral annular disjunction (MAD). Beta-blocker therapy was initiated with symptomatic improvement.
DISCUSSION: The EST unmasked both electrophysiological and auscultatory abnormalities entirely occult on standard resting evaluation. This case offers a practical diagnostic reference for recognizing latent cardiac diseases in patients with nonspecific symptoms.
TAKE-HOME MESSAGES: EST plays a crucial role in diagnosing atypical Barlow syndrome by unmasking both arrhythmias and characteristic auscultatory findings. Beta-blocker therapy effectively improves symptoms in patients with mitral annular disjunction-associated exercise-induced arrhythmias.
PMID:42886127 | DOI:10.1016/j.jaccas.2026.110384
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