Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive dyspnea on exertion (NYHA Class [II/III/IV]), orthopnea, and paroxysmal nocturnal dyspnea. History significant for [ischemic/non-ischemic] cardiomyopathy with reduced LVEF. Symptoms are refractory to optimized guideline-directed medical therapy (GDMT). No history of rheumatic fever or primary valvular disease.
Clinical Examination Findings
Cardiovascular exam reveals a displaced apical impulse. Auscultation demonstrates a holosystolic murmur, grade [II-IV/VI], best heard at the cardiac apex with radiation to the axilla. Signs of volume overload present, including [bilateral pedal edema/elevated JVP/basilar rales]. S3 gallop noted.
Treatment Protocol
Optimization of GDMT, including beta-blockers, ARNI/ACEi/ARB, MRA, and SGLT2 inhibitors. Evaluation for Cardiac Resynchronization Therapy (CRT) if indicated. Referral for Heart Team consultation to assess candidacy for transcatheter edge-to-edge repair (TEER) or surgical intervention given the severity of secondary MR and persistent symptoms despite maximal medical therapy.