How should patients with mitral regurgitation be followed?
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Patients with mild to moderate mitral regurgitation should be assessed periodically for a worsening condition; those with severe mitral regurgitation should be monitored for development of congestive heart failure, atrial fibrillation, and decline in left ventricular ejection fraction or increase in left ventricular end-diastolic diameter (strength of recommendation [SOR]=B). Cardiologists and general internists perform equally well in identifying severe mitral regurgitation among patients with known mitral regurgitation. Grade I or II murmurs indicate mild or moderate mitral regurgitation; grade IV or greater murmurs indicate severe mitral regurgitation, and grade III murmurs are indeterminate (SOR=B). The optimal frequency of evaluation is uncertain. Patients with severe regurgitation should be followed more frequently, with a combination of physical examination and echocardiography (SOR=B).
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