Mitral regurgitation: Difference between revisions
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{{Valvular emergencies DDX}} | {{Valvular emergencies DDX}} | ||
==Treatment== | ==Treatment<ref>DiSandro D et al. Acute Mitral Regurgitation Treatment & Management. eMedicine. Dec 28, 2015. http://emedicine.medscape.com/article/758816-treatment.</ref>== | ||
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. | ||
* | *Appropriate treatment if [[myocardial infarction]] to include cath or thrombolysis | ||
*Nitrates and diuresis may improve filling pressures and treat edema | *Pulmonary edema | ||
* | **Oxygen | ||
**Nitrates and diuresis may improve filling pressures and treat edema | |||
**Early intubation for impending respiratory failure | |||
*Decrease afterload | *Decrease afterload | ||
*Nitroprusside can be considered in normotensive patients to increase cardiac output and decrease MR | **Nitroprusside can be considered in normotensive patients to increase cardiac output and decrease MR | ||
* | **Intra aortic balloon pump may decrease afterload, increase forward cardiac output and reduce regurgitation | ||
*Intra aortic balloon pump may decrease afterload, increase forward cardiac output and reduce regurgitation | *Inotropes | ||
**Dobutamine pressor of choice as alpha agonism and increased afterload minimal compared to beta agonism<ref>Sonoda M et al. Effects of Dobutamine Infusion on Mitral Regurgitation. Echocardiography. 1998 Jan;15(1):13-20.</ref> | |||
**Do not alleviate tachycardia with BBs as mild to mod tachycardia allows less time for LV to backfill | |||
;Consult Cards/CT Surgery! | ;Consult Cards/CT Surgery! | ||
Revision as of 00:37, 21 February 2016
Background
Clinical Features
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]
Differential Diagnosis
Valvular Emergencies
Treatment[3]
Medical therapy is simply a measure to aid hemodynamic stabilization before surgery. The following measures may help to achieve hemodynamic stabilization before surgery.
- Appropriate treatment if myocardial infarction to include cath or thrombolysis
- Pulmonary edema
- Oxygen
- Nitrates and diuresis may improve filling pressures and treat edema
- Early intubation for impending respiratory failure
- Decrease afterload
- Nitroprusside can be considered in normotensive patients to increase cardiac output and decrease MR
- Intra aortic balloon pump may decrease afterload, increase forward cardiac output and reduce regurgitation
- Inotropes
- Dobutamine pressor of choice as alpha agonism and increased afterload minimal compared to beta agonism[4]
- Do not alleviate tachycardia with BBs as mild to mod tachycardia allows less time for LV to backfill
- Consult Cards/CT Surgery!
- Only real treatment is emergency surgery
See Also
Source
- ↑ 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.
- ↑ 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
- ↑ DiSandro D et al. Acute Mitral Regurgitation Treatment & Management. eMedicine. Dec 28, 2015. http://emedicine.medscape.com/article/758816-treatment.
- ↑ Sonoda M et al. Effects of Dobutamine Infusion on Mitral Regurgitation. Echocardiography. 1998 Jan;15(1):13-20.