Difference between revisions of "Valvular emergencies"

(Treatment)
(Mitral Stenosis)
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==Mitral Stenosis==
 
==Mitral Stenosis==
*Most common cause is rheumatic heart dz
 
 
===Diagnosis===
 
===Diagnosis===
 
*Mid-diastolic murmur
 
*Mid-diastolic murmur

Revision as of 21:55, 15 May 2011

Mitral Stenosis

Diagnosis

  • Mid-diastolic murmur
  • Symptoms
    • Exertional dyspnea
    • PND
    • Acute pulmonary edema
    • R-sided HF symptoms
    • Hemoptysis (pulm htn > ruptured bronchial vein)
    • Precipitants:
      • Anemia
      • Pregnancy
      • Infection
      • A-fib
  • ECG
    • RAD
    • Biphasic P waves
  • CXR
    • Straightening of right heart border

Treatment

  • Diuretics
    • Alleviates pulmonary congestion
  • A-fib treatment
  • Hemoptysis
    • Consider transfusion / surgery consult

Mitral Regurgitation

  • Acute
    • Most common cause is papillary / chordae rupture

Diagnosis

  • Acute MR
    • Suspect if new-onset pulm edema + normal heart size
    • Severe dyspnea, tachycardia, pulmonary edema
    • Cardiogenic shock may develop
    • S4, apical systolic murmur

Treatment

  • Decrease pulmonary edema
    • O2, nitrates, diuretics
  • Increase forward flow
    • Decrease afterload
    • Consider nitroprusside in normotensive pts

Aortic Stenosis

Diagnosis

  • Dyspnea, CP, syncope
    • Once symptoms present mean surival is 2-3yr
  • Late systolic murmur radiating to carotids
  • Pulsus parvus et tardus
  • Narrowed pulse pressure

Treatment

  • Admission
  • Avoid BBs, CCBs
  • Avoid afterload reduction
    • SV is fixed so could lead to profound hypotension
  • AS + A-fib = emergency
    • Consider emergent cardioversion
  • Pulm edema
    • Diuretics, intubation if necessary
    • Extreme caution with use of nitrates/vasodilators

Aortic Regurgitation

  • Causes
    • Endocarditis
    • Aortic dissection
    • Blunt chest trauma

Diagnosis

  • Pulmonary edema
  • Wide pulse pressure
  • Dyspnea
  • Hypotension (may progress to cardiogenic shock)
  • Diastolic murmur heard immediately after S2
  • CXR
    • Pulmonary edema w/o cardiac enlargement

Treatment

  • Immediate surgical intervention
  • Reduce afterload
    • Nitroprusside
  • Diuretics and nitrates don't work
  • Don't use beta blockers (block compensatory tachycardia)

See Also

Heart Murmurs

Source

Tintinalli