Date:
Patient:
Reason for Visit:
Follow-up for prosthetic heart valve (PHV) function
Evaluation of new symptoms (e.g., fatigue, shortness of breath, chest pain)
Possible valve dysfunction concerns
History:
Past Medical History (PMH):
Underlying cardiac condition necessitating valve replacement (e.g., aortic stenosis, mitral regurgitation)
Type of prosthetic heart valve implanted (mechanical, bioprosthetic)
Date of valve replacement surgery
Any complications from the surgery
Medications:
Anticoagulation medications (warfarin, newer oral anticoagulants) for mechanical valves
Medications to manage heart failure or other cardiac conditions
Social History:
Smoking history (can affect valve durability)
Diet and exercise habits
Presenting Complaint:
Describe the patient’s current concerns and symptoms, including onset, duration, and severity.
Examples: fatigue, shortness of breath on exertion, chest pain, palpitations, new-onset edema (swelling)
Functional Status:
Assess patient’s ability to perform daily activities (limitations due to symptoms)
Physical Exam:
Vital Signs: Assess blood pressure, heart rate, oxygen saturation, and temperature.
General: Look for signs of heart failure (edema, jugular venous distention).
Cardiovascular:
Listen for heart murmurs using a stethoscope. Murmurs may indicate valve dysfunction.
Assess for jugular venous pulsation (increased pressure in the jugular veins).
Assess for peripheral edema (swelling in legs or ankles).
Diagnostic Tests:
Electrocardiogram (ECG): May show signs of arrhythmias or heart chamber enlargement.
Chest X-ray: May show signs of heart enlargement or pulmonary edema (fluid in the lungs).
Echocardiogram (Echo): The most important test to assess prosthetic valve function. It evaluates valve opening and closing, blood flow across the valve, and potential complications.
Other Tests (may be ordered depending on clinical presentation):
Holter monitor (continuous ECG recording for 24-48 hours) to assess for arrhythmias
Exercise stress test to evaluate heart function during exertion
Assessment:
Prosthetic heart valve function: Normal, stenotic (narrowed), regurgitant (leaking), or obstructed.
Presence of complications: Paravalvular leak (leakage around the valve), endocarditis (infection of the valve)
Heart failure status (if present): Severity based on New York Heart Association (NYHA) classification
Plan:
Management plan: Based on valve function, symptoms, and overall health.
If valve function is normal, continue current medications and schedule regular follow-up.
If valve dysfunction is suspected:
Adjust anticoagulation therapy (if applicable)
Consider medication changes for heart failure management
Discuss potential need for valve replacement surgery (repeat procedure)
Address any identified complications (e.g., antibiotics for endocarditis)
Referral to a cardiologist specializing in valvular heart disease: May be needed for complex cases or consideration of valve replacement surgery.
Laboratory follow-up: Monitor blood work for signs of infection or to adjust anticoagulation medication dosage.
Imaging follow-up: Repeat echocardiogram at defined intervals to monitor valve function.
Patient education: Provide information about prosthetic heart valves, potential complications, importance of medication adherence, and healthy lifestyle habits to promote heart health.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of prosthetic heart valves.