mitral valve was noted in as many as 30 of 95 male patients with coronary heart disease.Systolic clicks were not heard in any of the cases studied.The finding of such a high percentage of mitral valve prolapse (MVP) in coronary heart disease is contrary to most published series on the systolic click-murmur syndrome (SCMS) where coronary angiography was invariably normal.'The reason for this discrepancy lies in the fact that Dr. Aranda's paper deals with papillary muscle dysfunction associated with coronary heart disease.On the other hand, the SCMS per se is a totally different entity in which the coronary vessels are usually normal and the MVP is subsequent to pathology involving the mitral valve apparatus or stems from left ventricular dysfunction.We have followed up two patients with the SCMS and coronary heart disease demonstrated on angiography.Both were successfully operated (double and triple coronary bypass) with clinical and ergo- metric evidence of improved coronary supply.However, in both patients prolapse of the mitral valve persisted as did the atypical chest pains and palpitations associated with the SCMS.In view of this, and in view of our findings in the study of the SCMS before and after beta-blockade,2 we are of the opinion that in the SCMS the coronary arteries are invariably normal.In cases where both conditions coexist, we believe that we are dealing with double patho- logical entities rather than etiologically related conditions.In the 30 male patients reported by the authors, the prolapse is part of the ischemic papillary muscle dysfunction complex and should be differentiated from the SCMS per se which is more common in females in whom typical anginal pains are lacking, coronary vessels are usually normal, systolic clicks are often present, the ST-T changes are not ischemic in nature,2 and in whom the myocardial lactate abnormalities were thought not to result from ischemia.3Hence, one must differentiate between the SCMS and MVP secon- dary to ischemic papillary muscle dysfunction.The beta-blockade test may be of help in this context.