• Age-related calcific degeneration

• Congenital bicuspid aortic valve

• Rheumatic heart disease

• Beta blockers

• Diuretics

• Statins

• Aortic valve replacement (SAVR or TAVR)

• Balloon valvuloplasty (Not a "fix" just temporary relief of symptoms)

• Avoid strenuous exercise

• Manage hypertension and cholesterol

• Monitor symptoms regularly

• Avoid dehydration

• Exertional dyspnea

• Angina

• Syncope

• Endocarditis

• Marfan Syndrome

• Rheumatic fever

• Congenital valve defects

• Dyspnea on exertion

• Palpitations

• Wide pulse pressure

• Diastolic decrescendo murmur at left sternal border

• Vasodilators such as an ACE inhibitor

• Diuretics if needed for volume overload

If symptoms worsen or if the patient develops a drop in their EF, we would consider an aortic valve replacement

• Regularly check echocardiograms

• Control blood pressure

• Cautiously engage in physical activity

• Rheumatic heart disease (most common)

• Congenital

• Severe mitral annular calcification

• Dyspnea and orthopnea

• Fatigue

• Hemoptysis (late sign)

• Diuretics

• Beta blockers or calcium channel blockers for rate control

• Anticoagulation if a-fib is present

• Mitral valve repair or replacement

• Sodium restriction

• Avoid fluid overload

• Monitor for signs of A-fib or heart failure

• Mitral valve prolapse

• Rheumatic fever

• Infective endocarditis

• Ischemic heart disease

• Fatigue

• Dyspnea

• Holosystolic murmur at apex radiating to axilla

• ACE inhibitors or ARBs

• Beta blockers

• Diuretics if fluid overloaded

• Anticoagulation if A-fib

Mitral valve repair or replacement

• Follow up with Cardiologist

• Avoid stimulants particularly if prolapse is present

• Exercise with caution

• Rheumatic heart disease

• Carcinoid syndrome

• Congenital defects

• Hepatomegaly

• Ascites

• Jugular venous distension

• Diastolic murmur at lower left sternal border

• Diuretics

• Aldosterone antagonists

Tricuspid valve repair or replacement

• Limit sodium

• Monitor for fluid retention

• Regular follow-ups

• Right ventricular dilation (from left-sided heart failure or pulmonary hypertension)

• Endocarditis (especially with IV drug use)

• Rheumatic disease

• Fatigue

• Peripheral edema

• Jugular venous distension

• Holosystolic murmur that increases with inspiration

• Diuretics

• Treat underlying cause

Tricuspid valve repair

• Sodium and fluid restriction

• Treat contributing conditions

• Monitor weight and fluid status

• Congenital (most common)

• Carcinoid syndrome

• Rheumatic disease

• Fatigue

• Cyanosis (in severe cases)

• Systolic murmur at left upper sternal border

Only really requires medication if RV failure is present

• Balloon valvuloplasty

• Valve replacement if severe

• Monitor with regular echocardiograms

• Avoid significant physical exertion if severe

• Pulmonary hypertension (most common)

• Congenital heart defects

• Post-surgical (e.g., TOF repair)

• Endocarditis

• Dyspnea

• Fatigue

• Peripheral edema

• Diastolic murmur at left upper sternal border

• Treat underlying pulmonary hypertension

• Diuretics for volume overload

We will (rarely) see a valve replacement- typically on congenital cases

• Monitor right-sided heart function

• Manage contributing lung conditions