Mitral Regurgitation Case #3

An asymptomatic 45-year-old male is being seen for a routine physical examination. His blood pressure is 110/85 mm Hg. A IV/VI mid-systolic murmur is appreciated at the cardiac apex, radiating to the axilla, occurring after a mid-systolic click. The murmur becomes louder with transient arterial occlusion, or TAO, and moves earlier in systole with standing from a squatting position. Assuming the condition is severe upon echocardiography, with an ejection fraction of 65%, what is the most appropriate course of action?

A. Start an ACE inhibitor, and repeat the echocardiogram in 1 year

B. Start nifedipine, and repeat the echocardiogram in 1 year

C. Mitral valve repair

D. Mitral valve replacement