Diagnosis and Management of Valvular Heart Disease in Emergency Medicine Richard S. Chen, MD, MBA a , Matthew J. Bivens, MD a , Shamai A. Grossman, MD, MS b,c, * A popular saying holds that if one can hear a heart murmur in the middle of a loud and busy emergency department, then by definition the murmur is significant. Whether or not this is actually true, it does capture the frustration emergency physicians feel when trying to diagnose or manage valvular pathologic conditions with familiar yet limited tools, such as the stethoscope, chest radiograph, bedside ultrasound, and electrocar- diogram (ECG). Sometimes the emergency physician makes a first diagnosis of a prob- lematic heart valve by noting a previously unmentioned murmur on examination. At other times, patients present to the emergency department (ED) with known valvular disease. Valvular pathologic conditions may be at the very root of the patient’s chief complaint, for example, in aortic stenosis causing syncope or acute left-sided valve failure leading to hemodynamic collapse. More often, a valvular pathologic condition is a chronic, sideline issue that, nevertheless, needs to be taken into account when managing patient’s other medical needs. The authors have nothing to disclose. a Harvard-Affiliated Emergency Medicine Residency, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, West Campus Clinical Center, Boston, MA 02215, USA b Clinical Decision Unit and Cardiac Emergency Center, Beth Israel Deaconess Medical Center, Boston, MA, USA c Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Road, Boston, MA 02215, USA * Corresponding author. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Road, Boston, MA 02215. E-mail address: sgrossma@bidmc.harvard.edu KEYWORDS  Heart murmur  Mechanical valve  Endocarditis  Aortic stenosis  Mitral regurgitation Emerg Med Clin N Am 29 (2011) 801–810 doi:10.1016/j.emc.2011.08.001 emed.theclinics.com 0733-8627/11/$ – see front matter Ó 2011 Elsevier Inc. All rights reserved.