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Valvular Disease Overview
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Valvular & Structural Heart DiseaseIntermediateIn progressOne-page PDF
AS, AR, MS, MR, TR overview; pathophysiology, murmur clues, echo monitoring intervals, intervention triggers, and referral.
Combines aortic, mitral, and tricuspid lesions on one overview sheet.
Last reviewed
Pending initial clinical review
Sources / guidelines to verify
- 2020 ACC/AHA Valvular Heart Disease Guideline
Disclaimer: Educational reference only. Not a substitute for clinician judgment, local protocols, or current guideline review.
One-page reference
Draft content pending the site owner’s clinical review. Verify against the sources above and local protocol before clinical use.
1
What it is / why it matters
- Aortic stenosis (AS), aortic regurgitation (AR), mitral stenosis (MS), mitral regurgitation (MR), tricuspid regurgitation (TR).
- Severity + symptoms + ventricular response drive the timing of intervention. Echo is the workhorse.
2
Key diagnostic clues
Murmurs
- AS: systolic crescendo–decrescendo radiating to carotids
- MR: holosystolic radiating to axilla
- AR: early diastolic, decrescendo
- MS: opening snap + diastolic rumble
Symptoms
- Dyspnea, angina, syncope, heart failure
3
Initial workup
- TTE to grade severity and assess LV size/function.
- Serial echo intervals by severity; TEE, cath, or CT as needed.
- Careful symptom history — patients often self-limit activity.
4
Management framework
- Refer to a valve / heart team for intervention decisions.
- Severe symptomatic AS → aortic valve replacement (TAVR or SAVR by heart team).
- Severe asymptomatic AS with LV dysfunction (EF <50%) or abnormal stress → consider AVR.
- Severe primary MR, symptomatic or with LV changes (EF 30–60% / LVESD ≥40 mm) → repair preferred.
- Medical therapy treats HF/AF/BP but does not fix mechanical lesions — don’t delay needed intervention.
5
Red flags / escalate now
- New heart failure, syncope, or angina with severe valve disease.
- Rapid symptom change → expedite referral.
6
Follow-up / monitoring
- Serial echo per severity (e.g., severe asymptomatic AS every 6–12 months; moderate every 1–2 years).
- Ongoing symptom surveillance and endocarditis awareness.
7
Clinic pearls
- Symptom onset in severe AS is a turning point — untreated prognosis is poor, so refer.
- "Asymptomatic" severe AS needs a careful history; TAVR vs SAVR is a heart-team decision.
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