. . e76 1.4. Scope of the Guideline . . . . . . . . . . . . . . . . . . . . . . e76 1.5. Class of Recommendation and Level of Evidence e77 1.6. Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e77 2. General Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e78 2.1. Evaluation of the Patient With Known or Suspected Native VHD . . . . . . . . . . . . . . . . . . . . . . . e78 2.2. Definitions of Severity of Valve Disease . . . . . . . . . e78 2.3. Diagnosis and Follow-Up e78 2.3.1. Diagnostic Testing: Initial Diagnosis 30 . . . e78 2.3.2. Diagnostic Testing: Changing Signs or Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . e80 2.3.3. Diagnostic Testing: Routine Follow-Up . . . . e80 2.3.4. Diagnostic Testing: Cardiac Catheterization . e81 2.3.5. Diagnostic Testing: Exercise Testing . . . . . . e81 2.4. Basic Principles of Medical Therapy . . . . . . . . . . . . e81 2.4.1. Secondary Prevention of Rheumatic Fever . e82 2.4.2. IE Prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . e82 2.4.3. 