Last reviewed: 20 Dec 2020
Last updated: 11 Sep 2020
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 S1
- irregularly irregular pulse
- flushed cheeks
Risk factors
- streptococcal infection
- female sex
- ergot medications
- serotogenic medications
- SLE
- amyloidosis
- bronchial carcinoid syndrome
Diagnostic investigations
Investigations to consider
- trans-oesophageal echocardiography
- cardiac catheterisation
- dynamic exercise testing
Treatment algorithm
Contributors
Authors

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
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.
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.
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