Prevention of Heart Murmur
Semantically, prevention of heart murmurs is not a legitimate medical goal, as the sense of what is meant should be described as,
“prevention of heart disease that results in the cardiac valvular disease that creates murmurs heard in auscultating the heart.”
As such, prevention is centered on the prevention of heart disease, specifically valvular disease and the conditions that cause it.
Rheumatic fever decreased significantly in incidence in industrialized nations it can be caused by acute rheumatic fever, which frequently goes undiagnosed. In the pathogenesis, the heart valves are colonized and damage to them is significant. Prompt diagnosis and antibiotic treatment for group A streptococcal infection (tonsils and pharynx), will prevent the more virulent outcome that rheumatic fever can cause.
Those with a history of rheumatic fever or rheumatic heart disease should be treated with continuous prophylactic antibiotics. Patients with previous history of valve damage, disease, repair, or replacement, should undergo a course of antibiotics prior to any planned invasive intervention, including dental procedures.
Drug Toxicity and Prevention of Valvular Heart Disease
Anorectic drugs such as fenfluramine/dexfenfluramine can be toxic to heart valves via destruction based on the altered serotonin biochemistry they cause phentermine is known to augment the pathogenic qualities of the former. Any patients who have been exposed to these agents should be evaluated thoroughly, and this includes auscultation of the heart for identifying any suspicious murmurs. If a murmur is found, echocardiography is an important, preventative next step in reducing mortality.
Prevention Associated with Renal Dialysis
Aortic stenosis associated with the advanced calcification seen in renal failure patients should prompt annual or semiannual echocardiography.
Pre-Existing Valvular Heart Disease
For those for whom a diagnosis of valvular heart disease is already established, prevention of further morbidity or possible mortality from sudden cardiac death must include surveillance for arrhythmias that are more likely with malfunctioning valves. Specifically, atrial fibrillation can deteriorate further into deadly cardiac dysfunction as cardiac output falls; or it can present the threat of thromboembolism requiring anticoagulant therapy to prevent stroke, myocardial ischemia, or other obstructive ischemia and tissue death.