# Heart valve disease - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-09 ## 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) ## Treatment metadata - Referral & safety-netting (no drug therapy) - Warfarin — 5 mg — oral.solid ## Complete treatment card ```text HEART VALVE DISEASE 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 against 2 sources listed above (2026-09) 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 Source StatPearls "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 Status traced to the source above Rx: Main treatment | Vitamin K antagonist MAIN TREATMENT 1. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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 Peds Children follow the same pathway: recognise and refer. Anticoagulation in a child with valve disease is set by paediatric cardiology. 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. Caution 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 [1st line] Adult 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 Peds Specialist paediatric cardiology management required. 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. Caution 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. Egypt HAEMOFARIN 5MG 100 TAB. EL NASR 11.00 EGP (0.11/unit) MARIVANIL 5MG 50 TAB. EL NILE. 5.60 EGP (0.11/unit) MAREVAN 5 MG 102 TABS. GLAXO SMITHKLINE 78.00 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)