Dawaa Reference

chronic

Heart valve disease

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD71 - condition scope only, no dose · Rheumatic Heart Disease - StatPearls - NCBI Bookshelf (NBK538286) - https://www.ncbi.nlm.nih.gov/books/NBK538286/ · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (warfarin monograph) · Heart Valve Disease - disease-level clinical article (heart-valve-disease-clinical.txt)

Verified against3 documents
  • Heart valve disease - disease-level clinical article (heart-valve-disease-clinical.txt)
  • Egyptian National Drug Formulary - Blood Disorder Medications 2025 (warfarin monograph)
  • Heart Valve Disease - disease-level clinical article (heart-valve-disease-clinical.txt)

Verified date2026-09

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Red flags (3)

  • Primary antibiotic prophylaxis after rheumatic fever runs for at least 10 years or until age 40, whichever is longer
  • Endocarditis prophylaxis before dental procedures is for prosthetic valves and prosthetic repair material, previous endocarditis, unrepaired congenital heart disease or repaired disease with a residual shunt, and cardiac transplant with valvular regurgitation
  • Thrombosis of a left-sided mechanical valve needs urgent fibrinolysis or emergency surgery

Tests (6)

  • Initial evaluation for every patient is history and physical examination, ECG, transthoracic echocardiogram and chest radiograph
  • Staging: A at risk, B progressive, C asymptomatic severe, D symptomatic severe
  • Asymptomatic severe primary mitral regurgitation: transthoracic echo every 6 to 12 months to watch left ventricular function and pulmonary artery pressure
  • Surgical bioprosthesis: surveillance echo every 5 to 10 years, then annually, even with no clinical change
  • Exercise testing can be used in asymptomatic severe aortic stenosis to look for symptoms and physiological changes; intervention is recommended if the findings are abnormal
  • Suspected infective endocarditis is diagnosed on the Modified Duke criteria, with transthoracic echo as the first-line imaging

If not this — what else fits (3)

  • Treat hypertension in asymptomatic aortic stenosis, and give a statin to every patient with calcific aortic stenosis
  • Anticoagulation for atrial fibrillation with valve disease follows CHA2DS2-VASc using a non-vitamin-K oral anticoagulant, except in mechanical valves, rheumatic mitral stenosis and bioprosthetic implantation within 3 months, where warfarin is used
  • Continue warfarin through minor procedures such as dental extraction or cataract surgery in a patient with a mechanical valve

SourceStatPearls "ACC/AHA Guidelines for Valve Disease" (NBK606116) - a summary of the 2022 guideline recommendations; it describes no symptoms or signs, so this card carries the workup, staging and prophylaxis only

Presentation findings are traced to the source above.

Rx: Main treatment | Vitamin K antagonist

MAIN TREATMENT

1

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Adult dose and duration

Rheumatic and degenerative valve disease are both seen regularly in Egypt. A GP recognises a murmur or symptoms, treats heart-failure symptoms if present, and refers for echocardiography and cardiology follow-up. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. Anticoagulation in a child with valve disease is set by paediatric cardiology.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Rheumatic and degenerative valve disease are both seen regularly in Egypt. A GP recognises a murmur or symptoms, treats heart-failure symptoms if present, and refers for echocardiography and cardiology follow-up.

Cautions
  • Breathlessness or oedema (heart failure), syncope, fever with a new murmur (possible endocarditis), rapid deterioration.
  • Echocardiography and a valve team are the pathway. Warfarin is the anticoagulation required in specific valve situations; whether to start it, and what INR to hold, is the cardiologist's decision.
  • RED FLAG - Antibiotic prophylaxis for infective endocarditis is needed before dental procedures in high-risk patients (prosthetic valves, prior IE, unrepaired CHD, transplant with regurgitation).
  • RED FLAG - All pregnant women with stage C and D valvular heart disease require pre-pregnancy counseling and tertiary care heart valve team monitoring.

VITAMIN K ANTAGONIST

2

WARFARIN

Vitamin K antagonist

1st line

Strength5 mg

Formoral.solid

Adult dose and duration

2 to 10 mg once daily initially, chosen by weight, age and general health, then adjusted by INR to a target of 2.5 (acceptable range 2.0 to 3.0) - long-term

Paediatric dose

Specialist paediatric cardiology management required.

Dose source

Egyptian National Drug Formulary - Blood Disorder Medications 2025 (warfarin monograph)

Why

The valve article requires a vitamin K antagonist, not a DOAC, for mechanical prosthetic valves, rheumatic mitral stenosis, and bioprosthetic valves implanted 3 months ago or less (heart-valve-disease-clinical.txt). It states no INR number; the target and the starting range are the Egyptian formulary's.

Cautions
  • Target INR is 2.0-3.0 (target 2.5); mandatory regular INR monitoring and dose titration.
  • Extensive cytochrome P450 drug interactions and dietary Vitamin K sensitivity; maintain consistent dietary greens intake and verify all concurrent medications.
  • Warfarin is contraindicated in the first trimester and during the last four weeks of pregnancy.
  • The 2.5 target is the general one. A mechanical mitral valve, an older valve design, or a systemic embolic event on a therapeutic INR all call for a higher target, which the cardiologist sets.
  • For atrial fibrillation with valve disease but NO mechanical valve, no rheumatic mitral stenosis and no recent bioprosthesis, the article prefers a DOAC chosen on the CHA2DS2-VASc score.
  • In pregnancy with a mechanical valve the regimen changes: warfarin may continue through all three trimesters only if the dose is 5 mg a day or less. Above that, low molecular weight heparin replaces it in the first trimester. This is specialist management.
  • The formulary's starting range is wide on purpose: it also gives a lower initial 2 to 7.5 mg for an elderly patient, and the same 2 to 7.5 mg where heparin or a low molecular weight heparin is running alongside, with the first INR checked on day 3 or 4.
Egyptian brands
Egyptian brandManufacturerIndicative price
HAEMOFARIN 5MG 100 TAB.EL NASR11.00 EGP (0.11/unit)
MARIVANIL 5MG 50 TAB.EL NILE.5.60 EGP (0.11/unit)
MAREVAN 5 MG 102 TABS.GLAXO SMITHKLINE78.00 EGP (0.76/unit)
COUMADIN 5 MG 28 TABLETS (ILLEGAL IMPORT)ZENTIVA >31.00 EGP (1.11/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.