Aortic Regurgitation Case #1

A 68-year-old male with a history of syphilis presents with generalized fatigue. He denies dyspnea, lower extremity edema or orthopnea. His blood pressure is 170/90 mm Hg and heart rate 80 beats per minute. A III/IV, short, early diastolic murmur is heard at the right upper sternal border. Systolic pulsation of the uvula and systolic capillary pulsations are seen upon light compression of the nail bed. Echocardiography confirms severe aortic valve regurgitation from a dilated aortic root. The ejection fraction is 60%. The left ventricular end systolic dimension is 5.7 cm and the left ventricular end diastolic dimension is 7.6 cm. Which of the following is the most appropriate course of action?

A. Start nifedipine, and repeat an echocardiogram in 6 months.

B. Start an ACE inhibitor, and repeat an echocardiogram in 6 months.

C. Start a beta-blocker, and repeat an echocardiogram in 6 months.

D. Surgical aortic valve replacement.