Valvular heart disease and congenital structural heart disease

I05.0-2/I05.8-9/I06.0-2/I06.8-9/I07.0-2/I07.8-9/I08.0-3/I08.8-9/I34.0-2/I34.8-9/I35.0-2/I35.8-9/I36.0-2/I36.8-9/I37.0-2/I37.8-9/Q22.0-6/Q22.8-9/Q23.0-4/Q23.8-9

DESCRIPTION

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

May be complicated by:

  • heart failure
  • atrial fibrillation
  • infective endocarditis
  • systemic embolism

GENERAL MEASURES

  • Advise all patients with a heart murmur regarding the need for prophylaxis 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

Prophylaxis 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 of age 750mg
5-10 years of age 1 500 mg
≥ 10 years ofage 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.