Abbreviation Meaning/Phrase ACE angiotensin-converting enzyme AF atrial fibrillation ARB angiotensin receptor blocker aPTT activated partial thromboplastin time AR aortic regurgitation AS aortic stenosis AVR aortic valve replacement BAV bicuspid aortic valve BNP B-type natriuretic peptide CABG coronary artery bypass graft surgery CAD coronary artery disease CMR cardiac magnetic resonance COR Class of Recommendation CT computed tomography ECG electrocardiogram GDMT guideline-directed management and therapy HF heart failure IE infective endocarditis INR international normalized ratio LA left atrium (left atrial) LMWH low-molecular-weight heparin CLINICAL STATEMENTS AND GUIDELINES 2. GENERAL PRINCIPLES 2.1. Evaluation of the Patient With Known or Suspected Native VHD Patients with VHD may present with a heart murmur, symptoms, or incidental findings of valvular abnormali- ties on noninvasive testing. Irrespective of the presenta- tion, all patients with known or suspected VHD should undergo an initial meticulous history and physical ex- amination. A detailed physical examination should be performed to diagnose and assess the severity of valve lesions. An electrocardiogram (ECG) to confirm heart rhythm and a chest x-ray to assess the presence or ab- sence of pulmonary congestion or other lung pathology may be helpful in the initial assessment of patients with known or suspected VHD. A comprehensive transtho- racic echocardiogram (TTE) with 2-dimensional (2D) im- aging and Doppler interrogation should be performed for diagnosis and evaluation of known or suspected VHD. The TTE also provides additional information, such as the effect of the valve lesion on the cardiac chambers and great vessels, as well as an assessment of other valve lesions. To determine the optimal treat- ment for a patient with VHD, ancillary testing may be required, such as transesophageal echocardiography (TEE), computed tomography (CT), cardiac magnetic resonance (CMR) imaging, stress testing, Holter moni- toring, diagnostic hemodynamic cardiac catheteriza- tion, or positron emission tomography (PET) combined with CT imaging. 