Valvular emergencies

Symptomatic

1. Mitral Regurg
   1. Rx: reduce afterload (e.g. nitroprusside, NTG)
   2. If 2nd to AMI, Rx: NTG
2. Mitral Stenosis
   1. Rx: rate control if tachy
   2. Associated with hemoptysis
   3. Transfuse + surg
3. Aortic Regurg
   1. Rx: reduce afterload (e.g. nitroprusside, NTG)
4. Aortic Stenosis
   1. Rx: rate control if tachy
   2. Do not reduce afterload!! (use nitrates very cautiously)
   3. Admit if symptomatic (e.g. syncope)
   4. + A.fib = emergency, consider emergent cardioversion

Consider emerg surg for all if primary cause of sx or refractory to Rx

See Also

Cards: Heart Murmur Sounds

Cards: Heart Murmur Manuvers

Source

10/07 DONALDSON (adapted from Tintinalli, emedicine)