ACUTE VALVULAR DISEASE.ppt

8/18/2019 ACUTE VALVULAR DISEASE.ppt

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ACUTE VALVULAR DISEASE ACUTE VALVULAR DISEASE

HOW TO DEAL WITH IN EMERGENCY ?HOW TO DEAL WITH IN EMERGENCY ?


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ACUTE REGURGITATION

• Acute Regurgitation caused b !"# Acute $a%$e d s&unction'# Acute on c(ronic d s&uction• Acute on c(ronic ! )reci)itated b increase in *etabo%ic

or (e*od na*ic re+uire*ents ,se)sis- b%eeding-)regnanc .

• T(e )resentation o& acute $a%$u%ar regurgitation *a be*ista/en &or ot(e acute conditions- suc( as se)sis-)neu*onia- or non$a%$u%ar (eart &ai%ure#


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Management of AcuteRegurgitation

1. Afterload reduction → decreases the regurgitant volume→ with nitroprusside, even in the setting of a normal blood

pressure

→ Use of IA ! can be beneficial for acute MR → IA ! is contraindicated in acute severe AR → worsen the

severit" of the acute AR#. $reatment of pulmonar" edema % o&"gent, diuretics,

nitrates and intubation if needed 'if respirator" failurehappened(


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). *o not attempt to alleviate tach"cardia with beta+

bloc er→ as compensator" mechanism→ in AR, tach"cardia reduce regurgitant volume

-. Rapid atrial fibrilation secondar" to chronic mitralregurgitation should be controlled with digo&inand diltia em


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$he /auses Acute MitralRegurgitation

• /hordae Rupture• 0ndocarditis• !apilar" muscle rupture• Acute rheumatic fever with carditis• Acute cardiom"opath"• !rosthetic valve d"sfuction


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!/I vs /onservative• 1- 2 patients had emergenc" cardiac catheteri ation '3

hours post infraction(• 42 patients significanr acute IMR• Acute Ischemic MR % mortalit" of #-5, at )2 da"s % -#5 at

3 months % 4#5

• Acute reperfusion 'thrombol"sis or angioplast"( did notreverse valvular incompetence

• $he greatest in hospital and 1 "ears mortalities were seenin patients perfused with emergenc" allon Angioplast",whereas patients managed medicall" or with /A 6 hadlower mortalities.


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$he /auses of Aortic Regurgitation

• 0ndocarditis• Aortic *issection 't"pe A(• Rupture 7enestration

• lunt /hest trauma• !rosthetic 8alve *"sfuction


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!rosthetic 8alve $hrombosis '!8$(


pressure→ Use of IA ! can be beneficial for acute MR

→ IA ! is contraindicated in acute severe AR → worsenthe severit" of the acute AR

#. $reatment of pulmonar" edema % o&"gent, diuretics,nitrates and intubation if needed 'if respirator" failurehappened(


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ACUTE VALVULAR DISEASE.ppt