Mitral regurgitation: Difference between revisions

m (Rossdonaldson1 moved page Mitral Regurgitation to Mitral regurgitation)
No edit summary
Line 1: Line 1:
===Diagnosis===
==Diagnosis==
*Most common cause is papillary / chordae rupture after MI<ref>Kosowsky JM: Infective Endocarditis and Valvular Heart Disease, in Marx JA, Hockberger RS, Walls RM, et al (eds): Emergency Medicine: Concepts and Clinical Practice, ed. 7. St. Louis, Mosby, Inc., 2010, (Ch) 81: p.1072-1074.</ref>
*Most common cause is papillary / chordae rupture after MI<ref>Kosowsky JM: Infective Endocarditis and Valvular Heart Disease, in Marx JA, Hockberger RS, Walls RM, et al (eds): Emergency Medicine: Concepts and Clinical Practice, ed. 7. St. Louis, Mosby, Inc., 2010, (Ch) 81: p.1072-1074.</ref>
**Day 2-7
**Day 2-7
Line 11: Line 11:
Clinical evaluation may be misleading leading to underestimation of mitral regurgitation severity. The classic holosystolic murmur can be much reduced in intensity. The tachycardia may make the murmur difficult to even appreciate. Even transthoracic echocardiography with color Doppler may be inadequate and underestimate the degree of regurgitation. <ref>Mitral Regurgitation, Ahmed MI, McGiffin DC, O'Rourke RA, Dell Italia LJ. Current Problems in Cardiology Volume 34, Issue 3, March 2009, Pages 93–136</ref>
Clinical evaluation may be misleading leading to underestimation of mitral regurgitation severity. The classic holosystolic murmur can be much reduced in intensity. The tachycardia may make the murmur difficult to even appreciate. Even transthoracic echocardiography with color Doppler may be inadequate and underestimate the degree of regurgitation. <ref>Mitral Regurgitation, Ahmed MI, McGiffin DC, O'Rourke RA, Dell Italia LJ. Current Problems in Cardiology Volume 34, Issue 3, March 2009, Pages 93–136</ref>


===Treatment===
==Treatment==


Medical therapy is simply a measure to aid hemodynamic stabilization before surgery. The following measures may help to achieve hemodynamic stabilization before surgery.
Medical therapy is simply a measure to aid hemodynamic stabilization before surgery. The following measures may help to achieve hemodynamic stabilization before surgery.
Line 34: Line 34:
*Kosowsky JM: Infective Endocarditis and Valvular Heart Disease, in Marx JA, Hockberger RS, Walls RM, et al (eds): Emergency Medicine: Concepts and Clinical Practice, ed. 7. St. Louis, Mosby, Inc., 2010, (Ch) 81: p.1072-1074.
*Kosowsky JM: Infective Endocarditis and Valvular Heart Disease, in Marx JA, Hockberger RS, Walls RM, et al (eds): Emergency Medicine: Concepts and Clinical Practice, ed. 7. St. Louis, Mosby, Inc., 2010, (Ch) 81: p.1072-1074.
2) [http://www.ncbi.nlm.nih.gov/pubmed/19232244 Ahmed MI et al. Mitral Regurgitation, Current Problems in Cardiology]
2) [http://www.ncbi.nlm.nih.gov/pubmed/19232244 Ahmed MI et al. Mitral Regurgitation, Current Problems in Cardiology]
 
<references/>


[[Category:Cards]]
[[Category:Cards]]

Revision as of 08:01, 31 January 2015

Diagnosis

  • Most common cause is papillary / chordae rupture after MI[1]
    • Day 2-7
  • MI, Endocarditis, Trauma
  • Severe dyspnea, tachycardia, pulmonary edema
  • Suspect if new-onset pulm edema + normal heart size
  • Cardiogenic shock may develop
  • S4, apical systolic murmur

Important to note; Clinical evaluation may be misleading leading to underestimation of mitral regurgitation severity. The classic holosystolic murmur can be much reduced in intensity. The tachycardia may make the murmur difficult to even appreciate. Even transthoracic echocardiography with color Doppler may be inadequate and underestimate the degree of regurgitation. [2]

Treatment

Medical therapy is simply a measure to aid hemodynamic stabilization before surgery. The following measures may help to achieve hemodynamic stabilization before surgery.

    • oxygen
    • Nitrates and diuresis may improve filling pressures and treat edema
    • Increase forward flow
    • Decrease afterload
    • Nitroprusside can be considered in normotensive patients to increase cardiac output and decrease MR
    • Inotropes may be required in hypotension
    • Intra aortic balloon pump may decrease afterload, increase forward cardiac output and reduce regurgitation
        • Consult Cards/CT Surgery!
  • Only real treatment is emergency surgery

See Also

Source

  • Tintinalli
  • Kosowsky JM: Infective Endocarditis and Valvular Heart Disease, in Marx JA, Hockberger RS, Walls RM, et al (eds): Emergency Medicine: Concepts and Clinical Practice, ed. 7. St. Louis, Mosby, Inc., 2010, (Ch) 81: p.1072-1074.

2) Ahmed MI et al. Mitral Regurgitation, Current Problems in Cardiology

  1. ↑ Kosowsky JM: Infective Endocarditis and Valvular Heart Disease, in Marx JA, Hockberger RS, Walls RM, et al (eds): Emergency Medicine: Concepts and Clinical Practice, ed. 7. St. Louis, Mosby, Inc., 2010, (Ch) 81: p.1072-1074.
  2. ↑ Mitral Regurgitation, Ahmed MI, McGiffin DC, O'Rourke RA, Dell Italia LJ. Current Problems in Cardiology Volume 34, Issue 3, March 2009, Pages 93–136
Retrieved from "https://www.wikem.org/w/index.php?title=Mitral_regurgitation&oldid=30378"