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A 28-year-old woman is evaluated for a 2-month history of increasing fatigue. A murmur was first heard 4 years ago, and echocardiography at that time showed mitral valve prolapse, moderate mitral regurgitation, and normal chamber sizes and function. Since then, annual echocardiography has documented stable mitral regurgitation and chamber sizes with the most recent echocardiogram 4 months ago.
On physical examination the patient appears healthy. Her heart rate is 76/min and blood pressure is 106/60 mm Hg. There is a mid-systolic click and a grade 3/6 late-systolic murmur beginning at the click. The remainder of the physical examination is unremarkable.
Which of the following is the best management for this patient?
( A ) Transthoracic echocardiography in 1 year
( B ) Immediate transthoracic echocardiography
( C ) Immediate transesophageal echocardiography
( D ) Immediate left heart ventriculography and coronary angiography
( E ) Mitral valve repair or replacement
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bb to lok for vegetations ?
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a
pt seems to be doing well?? am i missing something???
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C or B??
will go with C....look for vegetation though the murmur is not new?
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The patient has known moderate mitral regurgitation and a recent change in clinical status. However, her symptoms are nonspecific. Although an acute or chronic change in mitral regurgitation severity could be associated with symptoms such as these, so could anemia, hypothyroidism, or other nonrelated conditions.
Transthoracic echocardiography is indicated in a patient with known mitral regurgitation to establish the severity and mechanism of regurgitation, on an annual or semiannual basis for surveillance of left ventricular function, or to evaluate cardiac status after a change in symptoms. Transesophageal echocardiography is only indicated to establish the anatomic basis of mitral regurgitation to help guide surgical repair, or if transthoracic echocardiography is nondiagnostic. Heart catheterization with left ventriculography is only indicated if noninvasive testing is nondiagnostic, or if there is a discrepancy between clinical and noninvasive findings; coronary arteriography should be performed before mitral valve surgery in patients with angina, previous myocardial infarction, or risk factors for coronary artery disease.
Due to the patient™s change in symptoms, evaluation should not be deferred. Surgery is indicated for symptomatic severe mitral regurgitation, left ventricular systolic dysfunction, or substantial left ventricular dilation. If the patient™s symptoms are due to a change in mitral regurgitation severity with or without left ventricular systolic dysfunction, delaying surgery could result in permanent left ventricular dysfunction after surgery.
b
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* Transthoracic echocardiography is indicated in all patients with valvular heart disease after a change in symptoms.
* Surgery is indicated for symptomatic severe mitral regurgitation, left ventricular systolic dysfunction, or substantial left ventricular dilation.
