Last reviewed: 30 Oct 2023
Last updated: 13 Jan 2022
Summary
Definition
History and exam
Key diagnostic factors
- history of rheumatic fever
- dyspnea
- orthopnea
- opening snap on auscultation
- diastolic murmur
- loud P2
- neck vein distension
- paroxysmal nocturnal dyspnea
- hemoptysis
- hoarseness
- peripheral edema
- ascites
More key diagnostic factors
Other diagnostic factors
- 40 to 50 years old
- loud first heart sound (S1)
- irregularly irregular pulse
- flushed cheeks
Other diagnostic factors
Risk factors
- streptococcal infection
- female sex
- ergot medications
- serotonergic medications
- systemic lupus erythematosus (SLE)
- amyloidosis
- bronchial carcinoid syndrome
More risk factors
Diagnostic investigations
1st investigations to order
- ECG
- CXR
- transthoracic echocardiography
More 1st investigations to order
Investigations to consider
- transesophageal echocardiography
- cardiac catheterization
- dynamic exercise testing
More investigations to consider
Treatment algorithm
ONGOING
nonpregnant
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 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
- 2021 ESC/EACTS guidelines for the management of valvular heart disease
More GuidelinesPatient leaflets
Atrial fibrillation
Heart failure
More Patient leafletsVideos
Mitral stenosis (severe)
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