USMLE Step 3 - Question 25

A 42 year old female presents to with increasing dyspnea on exertion and lower extremity edema. She denies chest pains. Her temperature is 37.0, blood pressure 150/90, heart rate 100, respirations 20, and oxygen saturation 92% on room air. Physical examination reveals normal breath sounds, elevated jugular venous pressure, a III/VI holosystolic murmur at the apex occurring after a mid-systolic click, an S3 heart sound, and 1+ pitting lower extremity edema. Which of the following is the best treatment at this time?

A. ACE inhibition

B. Beta-blockade

C. Mitral valve repair

D. Mitral valve replacement

This patient has severe mitral valve regurgitation from mitral valve prolapse (MVP) which eventually leads to symptoms of congestive heart failure. When symptoms develop surgery is required to repair (not replace) the valve. Replacement is less ideal as complication rates are higher. Remember MVP is from myxomatous degeneration of the mitral valve apparatus and most commonly is benign without any mitral regurgitation. MVP is very common (some say 10% of females), however the development of mitral regurgitation is not common. Nevertheless, MVP remains the leading reason for mitral valve repair. Medication therapy to reduce afterload can help relieve symptoms, however once symptoms do develop from mitral regurgitation due to MVP, surgical repair is indicated.