Difference between revisions of "Valvular emergencies"

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==Mitral Stenosis==
==Differential Diagnosis==
{{Valvular emergencies DDX}}
*Mid-diastolic murmur
**Exertional dyspnea
**Acute pulmonary edema
**R-sided HF symptoms
**Hemoptysis (pulm htn > ruptured bronchial vein)
**Biphasic P waves
**Straightening of right heart border
**Alleviates pulmonary congestion
*A-fib treatment
**Consider transfusion / surgery consult
==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==
*Dyspnea, CP, syncope
**Once symptoms present mean surival is 2-3yr
*Late systolic murmur radiating to carotids
*Pulsus parvus et tardus
*Narrowed pulse pressure
*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==
**Aortic dissection
**Blunt chest trauma
*Pulmonary edema
*Wide pulse pressure
*Hypotension (may progress to cardiogenic shock)
*Diastolic murmur heard immediately after S2
**Pulmonary edema w/o cardiac enlargement
*Immediate surgical intervention
*Reduce afterload
*Diuretics and nitrates don't work
*Don't use beta blockers (block compensatory tachycardia)
==See Also==
==See Also==
[[Heart Murmurs]]
[[Heart Murmurs]]

Latest revision as of 04:52, 28 June 2016