Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- history 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 first heart sound (S1)
- irregularly irregular pulse
- flushed cheeks
Risk factors
- streptococcal infection
- female sex
- ergot medications
- serotonergic medications
- systemic lupus erythematosus (SLE)
- amyloidosis
- bronchial carcinoid syndrome
Diagnostic investigations
1st investigations to order
- ECG
- CXR
- trans-thoracic echocardiography
Investigations to consider
- trans-oesophageal echocardiography
- cardiac catheterisation
- dynamic exercise testing
Treatment algorithm
non-pregnant
pregnant
Contributors
Authors
Blase Carabello, MD

Jack Rose Distinguished Professor of Medicine
Brody School of Medicine
East Carolina University
Greenville
NC
Disclosures
BC declares that he has no competing interests.
Peer reviewers
John R. Charpie, MD, PhD
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
MI
Disclosures
JRC declares that he has no competing interests.
David Leaf, MD, MPH
Professor of Medicine
VA Greater Los Angeles Healthcare System
UCLA School of Medicine
Los Angeles
CA
Disclosures
DL declares that he has no competing interests.
Differentials
- Left atrial myxoma
- Unexplained atrial fibrillation
More DifferentialsGuidelines
- 2021 ESC/EACTS guidelines for the management of valvular heart disease
- 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines
More GuidelinesPatient leaflets
Atrial fibrillation: what is it?
Atrial fibrillation: what treatments work?
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