Difference between revisions of "Valvular emergencies"

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#[[Mitral Stenosis]]
#[[Mitral Stenosis]]
#[[Mitral Regurgitation]]
==Mitral Regurgitation==
*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
*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


  1. Mitral Stenosis
  2. Mitral Regurgitation

Aortic Stenosis


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


  • 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


  • 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


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

See Also

Heart Murmurs