Aortic regurgitation: Difference between revisions
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==Background== | ==Background== | ||
===Causes=== | |||
* | *[[Endocarditis]] | ||
* | *[[Aortic dissection]] | ||
**Blunt chest trauma | **Always suspect in acute aortic regurgitation | ||
*Blunt [[chest trauma]] | |||
== | ==Clinical Features== | ||
*Pulmonary edema | *[[Pulmonary edema]] | ||
*Wide pulse pressure | *Wide pulse pressure | ||
*Dyspnea | *[[Dyspnea]] | ||
*Hypotension (may progress to cardiogenic shock) | *[[Hypotension]] (may progress to cardiogenic shock) | ||
* | *Decrescendo diastolic [[murmur]] heard immediately after S2 | ||
=== | ==Differential Diagnosis== | ||
{{Valvular emergencies DDX}} | |||
==Evaluation== | |||
''Consider the following tests'' | |||
*[[CXR]] may be helpful | |||
**May see pulmonary edema with out cardiac enlargement | |||
**Left ventricular hypertrophy and dilated aorta | |||
*[[Cardiac ultrasound|Transthoracic echo]] will provide a more definitive diagnosis | |||
==Management== | |||
*Immediate surgical intervention | *Immediate surgical intervention | ||
*Reduce afterload | *Reduce afterload | ||
**Nitroprusside | **[[Nitroprusside]] | ||
*Diuretics and nitrates | *Inotropic support | ||
* | **[[Dobutamine]] | ||
*Diuretics and nitrates do ''not'' work | |||
*Do ''not'' use β-blockers (block compensatory tachycardia) | |||
==Disposition== | |||
==See Also== | ==See Also== | ||
[[Valvular Emergencies]] | *[[Valvular emergencies]] | ||
*[[Heart murmurs]] | |||
==External Links== | |||
* [http://www.emdocs.net/acute-valvular-emergencies-pearls-pitfalls/ emDocs - Acute Valvular Emergencies: Pearls and Pitfalls] | |||
* [https://recapem.com/valvular-emergencies-part-2-diagnosis-and-management-of-severe-aortic-regurgitation/ RECAP EM - Diagnosis and Management of Severe Aortic Regurgitation] | |||
[[Category: | ==References== | ||
<references/> | |||
[[Category:Cardiology]] | |||
Latest revision as of 15:21, 30 June 2021
Background
Causes
- Endocarditis
- Aortic dissection
- Always suspect in acute aortic regurgitation
- Blunt chest trauma
Clinical Features
- Pulmonary edema
- Wide pulse pressure
- Dyspnea
- Hypotension (may progress to cardiogenic shock)
- Decrescendo diastolic murmur heard immediately after S2
Differential Diagnosis
Valvular Emergencies
Evaluation
Consider the following tests
- CXR may be helpful
- May see pulmonary edema with out cardiac enlargement
- Left ventricular hypertrophy and dilated aorta
- Transthoracic echo will provide a more definitive diagnosis
Management
- Immediate surgical intervention
- Reduce afterload
- Inotropic support
- Diuretics and nitrates do not work
- Do not use β-blockers (block compensatory tachycardia)
Disposition
See Also
External Links
- emDocs - Acute Valvular Emergencies: Pearls and Pitfalls
- RECAP EM - Diagnosis and Management of Severe Aortic Regurgitation