Patient handout

Chronic secondary (functional) mitral regurgitation

PRODUCTION

1. Your condition

This handout is for chronic secondary (functional) mitral regurgitation. Your care team identified this based on: echo: significant mr with structurally normal leaflets + lv dilatation/tethering.

Other reasons your team may use this plan: hfref/hfpef with significant secondary mr; worsening dyspnea despite gdmt; rising nt-probnp with known functional mr.

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
sacubitril/valsartan	24/26→97/103 mg	PO	BID	PARADIGM-HF — reverse remodeling reduces functional MR; GDMT precedes any device decision (2022 ACC/AHA HF; 2020 VHD)
carvedilol	3.125→25 mg	PO	BID	Evidence-based BB — reverse remodeling reduces MR (2022 ACC/AHA HF)
spironolactone	12.5–25 mg	PO	once daily	RALES — MRA component of GDMT (2022 ACC/AHA HF)
dapagliflozin	10 mg	PO	once daily	DAPA-HF — SGLT2i pillar; benefit across the EF spectrum (2022 ACC/AHA HF)

Plan: Secondary MR — GDMT-first ladder then TEER (COAPT; 2020 ACC/AHA VHD; 2022 AHA/ACC/HFSA HF)

3. When to call your provider

Contact your care team if any of the following happen:

Persistent severe symptomatic MR on max the four foundational heart-failure medications ± CRT → TEER referral — COAPT
Decompensation/shock → ED + acute HF/shock pathway — 2022 ACC/AHA HF
End-stage / disproportionate MR → advanced HF — 2022 ACC/AHA HF

4. When to seek emergency care

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

NYHA II–IV severe 2°MR on maximal the four foundational heart-failure medications; heart pumping strength (LVEF) 20–50%; LVESD ≤70 mm; proportionate MR — TEER Class IIa — COAPT
Large LV (LVEDV high relative to EROA — disproportionate / MITRA-FR phenotype) — TEER benefit uncertain; prioritise advanced HF evaluation — MITRA-FR Obadia NEJM 2018
Pregnancy/planning — STOP RAS/SGLT2i/MRA; BB ± hydralazine/nitrate; cardio-obstetric; functional MR worsens with volume load — ESC 2018 Pregnancy
End-stage HF with refractory severe functional MR despite all therapy — advanced HF / transplant / durable MCS — 2022 ACC/AHA HF(life-threatening)

5. Follow-up

Co-manage with HFrEF engine; transplant/MCS if end-stage

6. Sources

Guideline: 2020 ACC/AHA VHD Guideline + 2021 ESC/EACTS VHD Guideline + 2022 AHA/ACC/HFSA HF Guideline