Valvular emergencies

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

Heart Murmurs

Source

Tintinalli