Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. Known history of [LV dysfunction/ischemic cardiomyopathy/dilated cardiomyopathy]. Symptoms are consistent with secondary mitral regurgitation due to ventricular remodeling and tethering of the mitral leaflets. No history of primary valvular disease, rheumatic fever, or endocarditis.
Clinical Examination Findings
Cardiovascular exam reveals a displaced apical impulse. Auscultation demonstrates a holosystolic murmur at the apex, radiating to the axilla, with a diminished S1. Signs of volume overload present, including elevated JVP, bilateral pedal edema, and bibasilar crackles on pulmonary auscultation. No evidence of click or opening snap.
Treatment Protocol
Initiate guideline-directed medical therapy (GDMT) including ACE inhibitors/ARBs/ARNIs, beta-blockers, and mineralocorticoid receptor antagonists. Diuretic therapy as needed for volume management. Evaluate for cardiac resynchronization therapy (CRT) if indicated. Surgical or transcatheter mitral valve intervention (e.g., TEER) to be considered if MR remains symptomatic despite optimal medical therapy.