Difference between revisions of "Valvular emergencies"

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==DDx==
 
==DDx==
 
#[[Mitral Stenosis]]
 
#[[Mitral Stenosis]]
 +
#[[Mitral Regurgitation]]
  
==Mitral Regurgitation==
 
===Diagnosis===
 
*Most common cause is papillary / chordae rupture after MI
 
*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==
 
==Aortic Stenosis==

Revision as of 21:05, 18 July 2011

DDx

  1. Mitral Stenosis
  2. Mitral Regurgitation


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
  • Afterload reduction is controversial
    • Consider cards consult
  • 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