Last reviewed: June 2019
Last updated: January  2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • hx of rheumatic fever
  • dyspnoea
  • orthopnoea
  • opening snap on auscultation
  • diastolic murmur
  • loud P2
  • neck vein distension
  • paroxysmal nocturnal dyspnoea
  • haemoptysis
  • hoarseness
  • peripheral oedema
  • ascites

Other diagnostic factors

  • 40 to 50 years old
  • loud S1
  • irregularly irregular pulse
  • flushed cheeks

Risk factors

  • streptococcal infection
  • female sex
  • ergot medications
  • serotogenic medications
  • SLE
  • amyloidosis
  • bronchial carcinoid syndrome

Diagnostic investigations

1st investigations to order

  • ECG
  • CXR
  • trans-thoracic echocardiography
Full details

Investigations to consider

  • trans-oesophageal echocardiography
  • cardiac catheterisation
  • dynamic exercise testing
Full details

Treatment algorithm


Authors VIEW ALL

Blase Carabello

Professor of Medicine

Icahn School of Medicine


Mount Sinai Beth Israel Department of Cardiology

New York



BC declares that he has no competing interests.

Peer reviewers VIEW ALL

Associate Professor of Pediatrics

Medical Director

Pediatric Cardiothoracic Intensive Care Unit

University of Michigan Congenital Heart Center

C.S. Mott Children's Hospital

Ann Arbor



JRC declares that he has no competing interests.

Professor of Medicine

VA Greater Los Angeles Healthcare System

UCLA School of Medicine

Los Angeles



DL declares that he has no competing interests.

Use of this content is subject to our disclaimer