A 45-year-old female is evaluated for a 12-month history of exertional dyspnea. She experiences shortness of breath during mild exertion, such as house chores and walking on flat surfaces. An echocardiogram shows findings consistent with moderate rheumatic mitral stenosis and minimal mitral regurgitation. Which of the following is the most appropriate initial management for this patient?
a) Percutaneous balloon mitral valvuloplasty
b) Mitral valve replacement
c) Medical management with diuretics and beta-blockers
d) Anticoagulation therapy with warfarin
