Valvular Heart Disease
Diagnosis/Definition
- Valvular heart disease can be congenital or acquired leading to valvular stenosis and/or regurgitation with an accompanying murmur.
- Not all murmurs are associated with valvular disease.
- To evaluate a murmur of unclear origin, please see the separate referral guideline.
Initial Diagnosis and Management
- History focused on symptoms of cardiac dysfunction (exercise tolerance, chest pain, dizziness, syncope, orthopnea), physical exam characterizing the murmur (timing, intensity, location, etc.) and looking for signs of dysfunction (rales, S3, S4, edema, jugular venous distention).
- PA and LAT CXR.
- 12 lead electrocardiogram.
- Echo/doppler examination useful in estimating severity of lesion(s) and left ventricle function.
- Echo/doppler not indicated in young asymptomatic individuals with short midsystolic murmurs (outflow murmurs) consistent with diagnosis of functional murmur.
- Endocarditis prophylaxis for procedures (AHA recommendations) for stenotic and/or regurgitant lesions.
- Rheumatic fever prophylaxis for well-established cases of rheumatic valvular heart disease.
Ongoing Management and Objectives
- Regular follow-up by the primary care manager (PCM) in order to avoid undetected deterioration in cardiac function. Regular visits should assess symptoms of cardiac disease (chest pain, dyspnea, and dizziness).
- Follow-up studies (echocardiogram, multiple gated acquisition scan, etc.) on a schedule as determined by the cardiology consultant.
- Specialty follow-up schedule and management recommendations as determined by cardiology consultant. Most patients who are asymptomatic do not need to be seen regularly by specialist unless certain criteria of progression are met.
Indications for Specialty Care Referral
Symptomatic patients with stenotic and/or regurgitant lesions.
Asymptomatic patients with progressive cardiac enlargement detected on CXR and/or echocardiogram.
Significant change in physical finding (auscultatory or otherwise).
Criteria for Return to Primary Care
Completed specialty care evaluation with ongoing care that can be accomplished by the PCM.
Chronic condition that can be managed by the PCM with intermittent consultation with the cardiologist.
