These are chronic acquired sequelae of Acute Rheumatic Fever or Acute Sequelae of Infective Endorcaditis or Ischaemic Heart Disease, consisting of valvular damage, usually left heart valves, with varied progression of severity and complications.

Congenital Heart Disease is a congenital chamber defects or vessel wall anomalies Valvular Heart Disease and Congenital Structural Heart Disease may be complicated by

• Heart failure

• Infective endocarditis

• Atrial fibrillation

• Systemic embolism eg Stroke

Non pharmacological

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

Referral should be considered from low level of care to high level of care where specialized (physician`s care) or super–specialized care (Cardiologist`s care) can be offered, those includes;

• All patients with heart murmurs for further assessment such as ECG, Echocardiogram

• All patients with heart murmurs not on a chronic management plan

• Development (New) of cardiac signs and symptoms

• Worsening of clinical signs and symptoms of heart disease

• Any newly developing medical condition, e.g. fever

• All patients with valvular heart disease for advice on prophylactic antibiotic treatment

• Prior to any invasive diagnostic or therapeutic process