New or progressive symptoms referable to the heart suggest a prosthetic valve disorder. Therefore, new or progressive dyspnea of any form, new onset or worsening of congestive heart failure, decreased exercise tolerance, or a change in chest pain compatible with ischemia all suggest valvular dysfunction. 14 Severe hemolytic anemia may indicate a paravalvular leak. Persistent fever in patients with prosthetic valves should be evaluated for possible endocarditis. Changes in valve position may be noted on chest radiographs if comparison views are available. Blood studies that may be helpful include a blood count with red blood cell indices and coagulation studies if the patient is on warfarin. Emergency echocardiographic studies should be requested if there is any question about valve dysfunction. Ultimately, echocardiography and/or cardiac catheterization may be required for diagnosis.
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