Valvular emergencies: Difference between revisions
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==Aortic Regurgitation== | ==Aortic Regurgitation== | ||
* | *Causes | ||
**Endocarditis | **Endocarditis | ||
**Aortic dissection | **Aortic dissection |
Revision as of 21:52, 15 May 2011
Mitral Stenosis
- Most common cause is rheumatic heart dz
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
Source
Tintinalli