What are the key clinical features to consider when assessing a patient for valvular heart disease?

When assessing a patient for valvular heart disease, key clinical features to consider include:

• Murmur characteristics: The nature of the heart murmur is a primary indicator for suspicion of valve disease.
• Symptoms: Presence of symptoms such as angina, breathlessness (especially on minimal exertion or at rest), and exertional syncope are important clinical features.
• Signs: Peripheral oedema and abnormal ECG findings can support suspicion of valve disease.
• Patient history: Family history of valve disease, age (particularly over 75 years), and medical history including atrial fibrillation are relevant factors.
• Heart sounds: An ejection systolic murmur with a reduced second heart sound, even without other symptoms, warrants consideration.

Urgent specialist assessment including echocardiography is recommended if there is a systolic murmur with exertional syncope or severe symptoms thought to be related to valve disease.

In summary, the assessment focuses on murmur characteristics, symptoms (angina, breathlessness, syncope), signs (peripheral oedema, ECG changes), and relevant history (family, age, atrial fibrillation) to guide further investigation and referral.

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