Valvular emergencies
Revision as of 21:04, 18 July 2011 by Rossdonaldson1 (talk | contribs) (moved Valvular Emergencies (Valve) to Valvular Emergencies)
DDx
Mitral Regurgitation
Diagnosis
- 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
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
- 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
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