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Chapter 49: Ischemic Mitral Regurgitation
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A 61-year-old man with a prior history of diet-controlled type 2 diabetes, ischemic heart disease, and COPD was referred for cardiology consultation for a heart murmur. He was a very active man without any cardiovascular symptoms. His physical examination revealed a 2/6 holosystolic murmur loudest at the apex. An echo was obtained showing normal valve leaflets, chords, and annulus; small central MR jet area of 15% LA on Doppler; and mildly dilated LV size with fixed regional wall motion abnormalities. According to the ACC/AHA stages for ischemic MR (IMR), at which of the following stages would this patient be?
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The answer is A. (Hurst’s The Heart, 14th Edition, Chap. 49) The clinical presentation and the echo findings are consistent with stage A, which includes asymptomatic patients at risk of MR, as is the case for this patient (option A). Stages B (option B), C (options C and D), and D (option E) typically include patients with progressive MR, asymptomatic patients with severe disease, and symptomatic subjects with severe MR, respectively. Options B through E are therefore not correct. Stages of secondary MR with associated valve anatomy, valve hemodynamics, cardiac findings, and symptoms are presented in Table 49-1.1
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