Posted by new from IP 66.212.131.19 on January 27, 2007 at 19:33:20:
A 43-year-old asymptomatic man is evaluated for a murmur heard during an employment physical. He last saw a physician 6 years ago, at which time he was told of a murmur, and echocardiography showed mitral valve prolapse.
On examination, his heart rate is 82/min and blood pressure is 124/68 mm Hg. Jugular venous distension is 8 cm H2O above the manubrium. The cardiac apex is displaced 3 cm laterally and is diffuse. There is a grade 2/6 blowing holosystolic murmur heard loudest at the apex with radiation to the left sternal border. The remainder of the physical examination is unremarkable.
Echocardiography shows mitral valve prolapse with partial posterior leaflet flail and severe mitral regurgitation. The left atrium and the left ventricle are enlarged, and the ejection fraction is 50%.
Which of the following is the best management for this patient?
( A ) A follow-up visit in 6 months
( B ) Lisinopril, 2.5 mg daily, increasing the dose as blood pressure tolerates
( C ) Lisinopril, 2.5 mg daily, increasing the dose as blood pressure tolerates, and furosemide, 40 mg daily
( D ) Refer for mitral valve surgery
( E ) Rest and exercise radionuclide ventriculography