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| ==Mitral Stenosis== | | ==Differential Diagnosis== |
| *Most common cause is rheumatic heart dz
| | {{Valvular emergencies DDX}} |
| ===Diagnosis===
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| *Mid-diastolic murmur
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| *Symptoms
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| **Exertional dyspnea
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| **PND
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| **Acute pulmonary edema
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| **R-sided HF symptoms
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| **Hemoptysis (pulm htn > ruptured bronchial vein)
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| **Precipitants:
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| ***Anemia
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| ***Pregnancy
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| ***Infection
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| ***A-fib
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| *ECG
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| **RAD
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| **Biphasic P waves
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| *CXR
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| **Straightening of right heart border
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| ===Treatment===
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| *Diuretics
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| **Alleviates pulmonary congestion
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| *A-fib treatment
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| *Hemoptysis
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| **Consider transfusion / surgery consult
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| ==Mitral Regurgitation== | | ==See Also== |
| *Acute | | *[[Heart Murmurs]] |
| **Most common cause is papillary / chordae rupture
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| ===Diagnosis===
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| *Acute MR
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| **Suspect if new-onset pulm edema + normal heart size
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| **Severe dyspnea, tachycardia, pulmonary edema
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| **Cardiogenic shock may develop
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| **S4, apical systolic murmur
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| ===Treatment===
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| *Decrease pulmonary edema
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| **O2, nitrates, diuretics
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| *Increase forward flow
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| **Decrease afterload
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| **Consider nitroprusside in normotensive pts
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| ==Aortic Stenosis==
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| ===Diagnosis===
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| *Dyspnea, CP, syncope
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| **Once symptoms present mean surival is 2-3yr
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| *Late systolic murmur radiating to carotids
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| *Pulsus parvus et tardus
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| *Narrowed pulse pressure
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| ===Treatment===
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| *Admission
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| *Avoid BBs, CCBs
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| *Avoid afterload reduction
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| **SV is fixed so could lead to profound hypotension
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| *AS + A-fib = emergency
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| **Consider emergent cardioversion
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| *Pulm edema
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| **Diuretics, intubation if necessary
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| **Caution with use of nitrates/vasodilators
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| ==Aortic Regurgitation==
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| *Causes
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| **Endocarditis
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| **Aortic dissection
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| **Blunt chest trauma
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| ===Diagnosis===
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| *Pulmonary edema
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| *Wide pulse pressure
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| *Dyspnea
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| *Hypotension (may progress to cardiogenic shock)
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| *Diastolic murmur heard immediately after S2
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| *CXR
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| **Pulmonary edema w/o cardiac enlargement
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| ===Treatment===
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| *Immediate surgical intervention
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| *Reduce afterload
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| **Nitroprusside
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| *Diuretics and nitrates don't work
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| *Don't use beta blockers (block compensatory tachycardia)
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| ==See Also== | | ==References== |
| [[Heart Murmurs]]
| | <references/> |
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| ==Source==
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| Tintinalli
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| [[Category:Cards]] | | [[Category:Cardiology]] |
