ACUTE VALVULAR DISEASE

HOW TO DEAL WITH IN EMERGENCY ?

ACUTE REGURGITATION
Acute Regurgitation caused by :
1. Acute valve dysfunction
2. Acute on chronic dysfuction
Acute on chronic : precipitated by increase in metabolic
or hemodynamic requirements (sepsis, bleeding,
pregnancy)
The presentation of acute valvular regurgitation may be
mistaken for othe acute conditions, such as sepsis,
pneumonia, or nonvalvular heart failure.

Management of Acute
Regurgitation
1. Afterload reduction
decreases the regurgitant volume
with nitroprusside, even in the setting of a normal blood
pressure
Use of IABP can be beneficial for acute MR
IABP is contraindicated in acute severe AR worsen the
severity of the acute AR
2. Treatment of pulmonary edema : oxygent, diuretics,
nitrates and intubation if needed (if respiratory failure
happened)

3. Do not attempt to alleviate tachycardia with betablocker

as compensatory mechanism
in AR, tachycardia reduce regurgitant volume
4. Rapid atrial fibrilation secondary to chronic mitral
regurgitation should be controlled with digoxin
and diltiazem

The Causes Acute Mitral

Regurgitation

Chordae Rupture
Endocarditis
Papilary muscle rupture
Acute rheumatic fever with carditis
Acute cardiomyopathy
Prosthetic valve dysfuction

PCI vs Conservative

1480 patients had emergency cardiac catheterization (6

hours post infraction)
50 patients significanr acute IMR
Acute Ischemic MR : mortality of 24%, at 30 days : 42% at
6 months : 52%
Acute reperfusion (thrombolysis or angioplasty) did not
reverse valvular incompetence
The greatest in hospital and 1 years mortalities were seen
in patients perfused with emergency Ballon Angioplasty,
whereas patients managed medically or with CABG had
lower mortalities.

The Causes of Aortic Regurgitation

Endocarditis
Aortic Dissection (type A)
Rupture Fenestration
Blunt Chest trauma
Prosthetic Valve Dysfuction

Prosthetic Valve Thrombosis (PVT)

1. Afterload reduction
decreases the regurgitant volume
with nitroprusside, even in the setting of a normal blood
pressure
Use of IABP can be beneficial for acute MR
IABP is contraindicated in acute severe AR worsen
the severity of the acute AR
2. Treatment of pulmonary edema : oxygent, diuretics,
nitrates and intubation if needed (if respiratory failure
happened)

Management of Acute
Regurgitation
1. Afterload reduction
decreases the regurgitant volume
with nitroprusside, even in the setting of a normal blood
pressure
Use of IABP can be beneficial for acute MR
IABP is contraindicated in acute severe AR worsen
the severity of the acute AR
2. Treatment of pulmonary edema : oxygent, diuretics,
nitrates and intubation if needed (if respiratory failure
happened)

Management of Acute
Regurgitation
1. Afterload reduction
decreases the regurgitant volume
with nitroprusside, even in the setting of a normal blood
pressure
Use of IABP can be beneficial for acute MR
IABP is contraindicated in acute severe AR worsen
the severity of the acute AR
2. Treatment of pulmonary edema : oxygent, diuretics,
nitrates and intubation if needed (if respiratory failure
happened)

Thank you!
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