{ "schema_version": 1, "kind": "condition", "id": "heart-valve-disease", "name": "Heart valve disease", "category": "chronic", "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)", "review_status": "reviewed", "verified_against": "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_date": "2026-09", "treatments": [ { "id": 869, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "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.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children follow the same pathway: recognise and refer. Anticoagulation in a child with valve disease is set by paediatric cardiology.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "heart-valve-disease" }, { "id": 870, "generic": "Warfarin", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "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)", "adult_duration": "long-term", "dose_source": "Egyptian National Drug Formulary - Blood Disorder Medications 2025 (warfarin monograph)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Specialist paediatric cardiology management required.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "HAEMOFARIN 5MG 100 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 11.0, "pack_count": 100, "unit_price": 0.11, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MARIVANIL 5MG 50 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 5.6, "pack_count": 50, "unit_price": 0.11, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAREVAN 5 MG 102 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 78.0, "pack_count": 102, "unit_price": 0.76, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "COUMADIN 5 MG 28 TABLETS (ILLEGAL IMPORT)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ZENTIVA >", "price_egp": 31.0, "pack_count": 28, "unit_price": 1.11, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "heart-valve-disease" } ] }