Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea (NYHA class [I-IV]), orthopnea, and paroxysmal nocturnal dyspnea. Reports associated palpitations, fatigue, and decreased exercise tolerance. No history of chest pain or syncope. Symptoms are consistent with chronic volume overload secondary to severe primary mitral regurgitation.
Clinical Examination Findings
Cardiovascular exam reveals a hyperdynamic precordium with a laterally displaced apical impulse. Auscultation demonstrates a holosystolic murmur (grade [III-VI]/VI) heard best at the apex, radiating to the left axilla. S1 is soft; S2 may be widely split. Presence of an S3 gallop suggests significant left ventricular volume overload. No peripheral edema noted.
Treatment Protocol
Management plan includes initiation of guideline-directed medical therapy (GDMT) including diuretics for symptom control and ACE inhibitors/ARBs/ARNI for afterload reduction. Referral for surgical consultation (mitral valve repair vs. replacement) is indicated given the severity of primary MR. Serial echocardiographic monitoring of LV dimensions and EF is required.