Valvular Heart Disease and Congenital Structural Heart Disease

Description

General Measures

Medicine Treatment

Referral

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DESCRIPTION

Damage to heart valves, chamber or vessel wall anomalies caused by rheumatic fever or other causes, e.g. congenital heart defects, degenerative disease and ischaemic heart disease. 

May be complicated by:

• Heart failure 
• Atrial fibrillation
• Infective endocarditis 
• Systemic embolism
• Pulmonary hypertension

GENERAL MEASURES

• Advise all patients with a heart murmur regarding the need for prophylactic treatment prior to undergoing certain medical and dental procedures
• Advise patients to inform health care providers of the presence of the heart murmur when reporting for medical or dental treatment

MEDICINE TREATMENT

Prophylactic antibiotic treatment for infective endocarditis:

• Should be given prior to certain invasive diagnostic and therapeutic procedures e.g. tooth extraction, to prevent infective endocarditis
• Is essential for all children with congenital or rheumatic heart lesions needing dental extraction

Dental extraction, if no anaesthetic is required:
Z29.2

• Amoxicillin, oral, 50 mg/kg (maximum dose: 2 g), 1 hour before the procedure
  • Repeat dose 6 hours later

Age	Dose
< 5 years	750 mg
5–10 years	1 500 mg
≥ 10 years	2 g

Severe penicillin allergy:
Z88.0

Refer

If anaesthetic is required:

Refer

Prophylaxis for rheumatic fever:

See: Rheumatic fever, acute

REFERRAL

• All patients with pathological heart murmurs for assessment
• All patients with heart murmurs not on a chronic management plan
• Development of cardiac signs and symptoms
• Worsening of clinical signs and symptoms of heart disease
• Any newly developing medical condition, e.g. persistent fever
• All patients with valvular heart disease for advice on prophylactic antibiotic treatment prior to any invasive diagnostic or therapeutic procedure

Click here for the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_1 November 2024

Chapter 4: Cardiovascular Conditions_4.10 Valvular Heart Disease and Congenital Structural Heart Disease