Valvular emergencies

DDx

  1. Mitral Stenosis
  2. Mitral Regurgitation


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

Heart Murmurs

Source

Tintinalli