MRCP2-0183

MRCP2-0183

A 65-year-old man with mitral regurgitation presents to the cardiology clinic. During an ECG, he is found to have new-onset atrial fibrillation. He reports feeling well and denies any chest pain or shortness of breath. His blood pressure is 120/90 mmHg and his heart rate is 62 beats per minute. On examination, an S3 is audible and a 3/5 pansystolic murmur is heard loudest in the mitral area, with a displaced apex beat. A recent echocardiogram showed a regurgitant mitral valve with evidence of left atrial and ventricular dilatation, but preserved ejection fraction. He is currently taking naproxen for osteoarthritis and over-the-counter vitamin D supplements. What would be the most appropriate next step?