Patient handout

Chronic primary (degenerative) mitral regurgitation

PRODUCTION

1. Your condition

This handout is for chronic primary (degenerative) mitral regurgitation. Your care team identified this based on: apical holosystolic murmur radiating to axilla.

Other reasons your team may use this plan: echo: severe primary mr (eroa ≥0.40 cm², regvol ≥60 ml, rf ≥50%); echo: mv prolapse / flail leaflet; exertional dyspnea / reduced exercise tolerance.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
clinical surveillance (no primary-MR-directed pharmacotherapy)	—	—	—	No drug alters primary-MR natural history. Watchful-waiting yields survival ≈ expected: Rosenhek Circulation 2006 (PMID 16651470); Zilberszac JACC-Img 2018 overall-survival SMR 0.667 (0.463–0.963), P=0.013 (PMID 30031699). Surveillance TTE q1–2 y (moderate) per 2020 ACC/AHA VHD (PMID 33342586)

Plan: Primary MR severity/symptom/LV-staged management ladder — surveillance interval → asymptomatic-severe trigger thresholds → intervention; NO disease-modifying drug (2020 ACC/AHA VHD; 2021/2025 ESC/EACTS VHD)

3. When to call your provider

Contact your care team if any of the following happen:

Symptoms OR heart pumping strength (LVEF) ≤60% OR LVESD ≥40 mm OR new AF OR PASP >50 → surgical referral now — 2020 ACC/AHA VHD
Flail with decompensation → ED + acute MR pathway — 2020 ACC/AHA VHD
Syncope / malignant arrhythmia in arrhythmic MVP → EP + ICD evaluation — arrhythmic-MVP literature

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Symptomatic severe primary MR with heart pumping strength (LVEF) >30% — Class I mitral surgery (repair preferred) — 2020 ACC/AHA VHD
Asymptomatic severe primary MR with heart pumping strength (LVEF) 30–60% OR LVESD ≥40 mm — Class I surgery — 2020 ACC/AHA VHD
Bileaflet MVP + mitral annular disjunction + complex ventricular ectopy/NSVT — SCD risk; Holter + CMR (LGE), consider ICD if malignant arrhythmia — arrhythmic-MVP literature
Severe primary MR + pregnancy/planning — pre-pregnancy repair preferred; if pregnant use diuretic + hydralazine (avoid ACEi/ARB); mWHO risk class; cardio-obstetric team — ESC 2018 Pregnancy
New/worsening MR with fever/vegetation — infective endocarditis driving leaflet destruction — route to IE engine for surgery timing — 2020 ACC/AHA VHD

5. Follow-up

Post-repair surveillance; route to HFrEF engine if LV dysfunction (stage C2) develops

6. Sources

Guideline: 2020 ACC/AHA VHD Guideline (Otto/Nishimura, JACC 33342586 / Circ 33332149) + 2021 ESC/EACTS VHD Guideline (Vahanian 34453165); 2025 ESC/EACTS VHD LVESDi refinement layered on