A 58-Year-Old Computer Engineer Is Evaluated for a Murmur Heard

A 58-year-old computer engineer is evaluated for a murmur heard during a routine physical.  He has no symptoms and no significant medical history.  Specifically, he has no dyspnea, chest pain, syncope, or lower extremity swelling.  The patient smokes a cigar and drinks a glass of brandy every Friday night.  His lifestyle is mostly sedentary, but he walks for several miles on weekends.  Blood pressure is 122/69 mm Hg and pulse is 72/min.  There is no jugular venous distension.  Vesicular breath sounds are auscultated bilaterally.  There is a 3/6 holosystolic murmur best heard at the apex.  Echocardiogram shows the mitral valve cusps bulging into the left atrium during systole, and there is severe mitral regurgitation.  The left ventricle is dilated with ejection fraction of 52%.  Which of the following is the most appropriate next step in management of this patient?

A) Angiotensin receptor blocker
B) Beta adrenergic blocker
C) Referral for mitral valve repair
D) Referral to an exercise program
E) Repeat echocardiogram in 6 months

Correct Answer:

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