When should I consider referring a patient with aortic regurgitation to a cardiologist?

Consider referring a patient with aortic regurgitation to a cardiologist if they have moderate or severe valve disease of any type, including aortic regurgitation. Referral is also indicated for adults with bicuspid aortic valve disease of any severity. Specifically for aortic regurgitation, consider referral for intervention if the patient is asymptomatic but has a left ventricular ejection fraction (LVEF) less than 55%, or an end systolic diameter (ESD) greater than 50 mm or an end systolic diameter index (ESDI) greater than 24 mm/m² on echocardiography. Additionally, urgent referral is warranted if the patient has severe symptoms such as angina or breathlessness on minimal exertion or at rest that are thought to be related to valvular heart disease.

In pregnant women or those considering pregnancy, refer to a cardiologist with expertise in pregnancy care if they have moderate or severe valve disease or bicuspid aortic valve disease of any severity, regardless of symptoms.