Patient handout

Valvular heart disease (AS / AR / MR / MS)

PRODUCTION

1. Your condition

This handout is for valvular heart disease (as / ar / mr / ms). Your care team identified this based on: new systolic or diastolic murmur on examination (acc/aha 2020 vhd otto section 3).

Other reasons your team may use this plan: syncope, angina, or hf in patient with as (acc/aha 2020 vhd stage d criteria); acute severe mr / ar with pulmonary edema or shock (acc/aha 2020 vhd section 7–8); incidental valvular finding on imaging (acc/aha 2020 vhd stage a-b evaluation).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
furosemide	20-40 mg IV/PO	IV/PO	titrated to volume status	2020 AHA/ACC VHD — symptomatic relief; avoid in severe AS preload-dependent unless overloaded
lisinopril	5-10 mg PO	PO	daily	2020 AHA/ACC VHD — afterload reduction in chronic AR (Class IIa)
valsartan	40-80 mg PO	PO	BID	ARB alternative (ACC/AHA 2020 VHD Section 6 AR afterload reduction)
sacubitril/valsartan	24/26 mg PO	PO	BID; titrate q2-4 wks	PARADIGM-HF (McMurray NEJM 2014) — reduces secondary MR severity by reverse remodeling (ACC/AHA 2020 VHD Section 7)
metoprolol_succinate	25 mg	PO	daily	Rate control + GDMT (ACC/AHA 2020 VHD Section 9 MS; ESC 2021 VHD)
carvedilol	3.125 mg	PO	BID; titrate	COPERNICUS (Packer NEJM 2001); ACC/AHA 2020 VHD GDMT for secondary MR
amlodipine	5 mg	PO	daily	Neutral in AS; avoid non-DHP if LV dysfunction (ACC/AHA 2020 VHD Section 5)
warfarin	Titrate INR 2.5-3.5 (mechanical mitral) OR 2.0-3.0 (aortic mech)	PO	daily	2020 AHA/ACC — mandatory for mechanical valve and rheumatic MS+AF
apixaban	5 mg BID (2.5 mg per criteria)	PO	BID	ARISTOTLE — preferred DOAC for non-mechanical, non-rheumatic AF
amoxicillin	2 g PO	PO	30-60 min before procedure	2023 update — high-risk only (prosthetic, prior IE, congenital, transplant valvulopathy)
clindamycin	600 mg PO	PO	30-60 min before	AHA prophylaxis alternative

Plan: Medical management — GDMT, rate control, afterload reduction (lesion-specific)

3. When to call your provider

Contact your care team if any of the following happen:

New symptoms in severe asymptomatic → expedite intervention (ACC/AHA 2020 VHD Class I)
Decompensation → ED (ACC/AHA 2020 VHD)
New AF → anticoag adjustment (ACC/AHA 2020 VHD Section 10)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Severe AS (mean gradient ≥40, peak velocity ≥4.0, AVA ≤1.0) with syncope, angina, or HF
Acute severe MR (papillary rupture, IE, chordal rupture) with pulmonary edema or shock(life-threatening)
Acute severe AR from dissection or IE with pulmonary edema(life-threatening)
Secondary MR + HFrEF + NYHA III-IV on optimal the four foundational heart-failure medications with EROA ≥30 mm² + LV ESD ≤70 mm
Severe MS (MVA ≤1.5) + pulmonary hypertension or symptoms
Suspected or confirmed IE with valvular involvement + embolic / abscess / refractory bacteremia(life-threatening)
Mechanical valve with INR <2.0 (mitral) or <1.5 (aortic with risk factors)

5. Follow-up

Cardiology / structural / cardiothoracic surgery; cardiac rehab post-procedure; vaccinations; dental clearance pre-procedure (ACC/AHA 2020 VHD; 2023 focused update IE prophylaxis)

6. Sources

Guideline: 2020 AHA/ACC VHD Guideline (Otto/Nishimura) + 2023 focused update