CLINICIAN VALVE DISEASE GUIDE · SECTION 2 OF 3
Assess functional change, review the echo, and determine referral urgency.
Severe dyspnea, pulmonary edema, hemodynamic instability, ongoing chest pain, or syncope with concerning findings needs acute evaluation. Activate EMS for an unstable patient.
A new murmur with fever, systemic illness, or rapid deterioration raises concern for endocarditis or acute valve dysfunction and warrants urgent assessment. Prosthetic valve patients with new symptoms also need timely evaluation.[1], [5]
Document dyspnea, fatigue, exertional chest discomfort, dizziness/syncope, palpitations, orthopnea, and edema. Compare walking distance, stairs, exercise, and daily activities with the prior baseline.
Ask whether the patient has quietly reduced activity to avoid symptoms. “I feel fine” is less informative when the patient no longer does what they used to do.[2]
Record vital signs, murmur characteristics, congestion, and perfusion. Review the latest echo report and its date; correlate findings with current symptoms.
Stenosis, regurgitation, or mixed disease; native, repaired, or prosthetic valve.
The report’s integrated severity assessment and any discordant findings.
Ventricular function/size, atrial enlargement, pulmonary pressure, and other valve disease.
Progression since the previous study, new symptoms, or new chamber dysfunction.
Cardiology can arrange imaging or additional testing when the prior study is outdated, symptoms change, or the clinical picture does not match the report.[1]
Cardiology assessment to define the lesion.
Expedited cardiology/valve-team assessment.
Continue coordinated surveillance; reassess sooner for clinical change.
Do not wait for major functional loss before referring severe disease. Selected asymptomatic patients may benefit from intervention assessment; timing is determined by the valve team.[1], [3]
Send the symptom timeline, echo reports, EKG, medication list, and prior valve procedure details. Confirm who owns surveillance and when the next visit/imaging review is due. Intervals depend on lesion, severity, ventricular response, and progression.
Give clear instructions to report new dyspnea, chest discomfort, reduced exercise tolerance, fainting, or swelling. A change in symptoms should trigger reassessment rather than waiting for the next scheduled study.[2], [4]
For clinician education. Illustrations are simplified; treatment and surveillance are individualized by the valve team.