05-18-2007, 11:46 AM
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
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