Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea (NYHA class [I-IV]), orthopnea, and paroxysmal nocturnal dyspnea. Associated symptoms include palpitations, fatigue, and occasional lightheadedness. No history of chest pain or syncope. Known primary mitral valve pathology (e.g., prolapse, flail leaflet, rheumatic disease) with [duration] of symptoms.
Clinical Examination Findings
Cardiovascular exam reveals a hyperdynamic precordium with a displaced apical impulse. Auscultation demonstrates a holosystolic murmur, grade [I-VI/VI], loudest at the cardiac apex, radiating to the left axilla. S1 is typically soft; S2 may be widely split. No evidence of peripheral edema or jugular venous distension unless in decompensated heart failure.
Treatment Protocol
Management plan includes: 1. Medical therapy: ACE inhibitors/ARBs, beta-blockers, and diuretics as indicated for symptom control. 2. Monitoring: Serial echocardiography to assess LV dimensions, EF, and pulmonary artery pressures. 3. Surgical/Interventional: Evaluation for mitral valve repair vs. replacement if criteria for severe MR are met, or if LV dysfunction develops.