Difference between revisions of "Valvular emergencies"

(Aortic Regurgitation)
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==Mitral Stenosis==
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==Differential Diagnosis==
*Most common cause is rheumatic heart dz
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{{Valvular emergencies DDX}}
===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==
 
*Chronic
 
**Most common cause is ischemia/infarction
 
*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
 
**AS pts are preload dependent
 
**Consider emergent cardioversion
 
*Pulm edema
 
**Diuretics, intubation if necessary
 
**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==
 
==See Also==
 
[[Heart Murmurs]]
 
[[Heart Murmurs]]
  
==Source==
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==References==
Tintinalli
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<references/>
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[[Category:Cards]]
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[[Category:Cardiology]]

Latest revision as of 04:52, 28 June 2016