Diferencia entre revisiones de «Aortic regurgitation»
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==Background== | ==Background== | ||
[[File:Blausen 0041 AorticValve Regurgitation.png|thumb|Drawing of aortic regurgitation.]] | |||
===Causes=== | ===Causes=== | ||
*[[Endocarditis]] | *[[Endocarditis]] | ||
*[[Aortic dissection]] | *[[Aortic dissection]] | ||
**Always suspect in acute aortic | **Always suspect in acute aortic regurgitation | ||
*Blunt [[chest trauma]] | *Blunt [[chest trauma]] | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:Phonocardiograms from normal and abnormal heart sounds.svg|thumb|Phonocardiograms of common cardiac murmurs.]] | |||
*[[Pulmonary edema]] | *[[Pulmonary edema]] | ||
*Wide pulse pressure | *Wide pulse pressure | ||
*Dyspnea | *[[Dyspnea]] | ||
*[[Hypotension]] (may progress to cardiogenic shock) | *[[Hypotension]] (may progress to cardiogenic shock) | ||
*Decrescendo diastolic [[murmur]] heard immediately after S2 | *Decrescendo diastolic [[murmur]] heard immediately after S2 | ||
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==Evaluation== | ==Evaluation== | ||
[[File:Aortic insufficiency.gif|thumb|Aortic regurgitation shown on echocardiography: an abnormal stream of blood is visible, regurgitating from the insufficiency aortic valve to the apex of the left ventricle (apical projection, the apex of the heart is at the top of the image).]] | |||
[[File:Severe aortic regurgitation E00181 (CardioNetworks ECHOpedia).jpg|thumb|Severe aortic regurgitation shown on echo with M-Mode through aortic valve.]] | |||
[[File:Severe aortic regurgitation E00235 (CardioNetworks ECHOpedia).jpg|thumb|Subcostal view: pulsed-wave Doppler signal from abdominal aorta: diastolic flow reversal showing severe aortic regurgitation.]] | |||
''Consider the following tests'' | ''Consider the following tests'' | ||
*[[CXR]] may be helpful | *[[CXR]] may be helpful | ||
**May see pulmonary edema with out cardiac enlargement | **May see pulmonary edema with out cardiac enlargement | ||
**Left ventricular hypertrophy and dilated aorta | **Left ventricular hypertrophy and dilated aorta | ||
*[[ | *[[Cardiac ultrasound|Transthoracic echo]] will provide a more definitive diagnosis | ||
==Management== | ==Management== | ||
===Chronic=== | |||
===Acute=== | |||
*Immediate surgical intervention | *Immediate surgical intervention | ||
*Reduce afterload | *Reduce afterload | ||
**[[Nitroprusside]] | **[[Nitroprusside]] | ||
*Diuretics and nitrates do not work | *Inotropic support | ||
*Do not use | **[[Dobutamine]] | ||
*Diuretics and nitrates do ''not'' work | |||
*Do ''not'' use β-blockers (block compensatory tachycardia) | |||
==Disposition== | ==Disposition== | ||
===Chronic=== | |||
===Acute=== | |||
==See Also== | ==See Also== | ||
*[[Valvular emergencies]] | *[[Valvular emergencies]] | ||
*[[Heart murmurs]] | *[[Heart murmurs]] | ||
==External Links== | |||
* [http://www.emdocs.net/acute-valvular-emergencies-pearls-pitfalls/ emDocs - Acute Valvular Emergencies: Pearls and Pitfalls] | |||
* [https://recapem.com/valvular-emergencies-part-2-diagnosis-and-management-of-severe-aortic-regurgitation/ RECAP EM - Diagnosis and Management of Severe Aortic Regurgitation] | |||
==References== | ==References== | ||
<references/> | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Revisión actual - 18:34 13 nov 2024
Background
Causes
- Endocarditis
- Aortic dissection
- Always suspect in acute aortic regurgitation
- Blunt chest trauma
Clinical Features
- Pulmonary edema
- Wide pulse pressure
- Dyspnea
- Hypotension (may progress to cardiogenic shock)
- Decrescendo diastolic murmur heard immediately after S2
Differential Diagnosis
Valvular Emergencies
Evaluation
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Consider the following tests
- CXR may be helpful
- May see pulmonary edema with out cardiac enlargement
- Left ventricular hypertrophy and dilated aorta
- Transthoracic echo will provide a more definitive diagnosis
Management
Chronic
Acute
- Immediate surgical intervention
- Reduce afterload
- Inotropic support
- Diuretics and nitrates do not work
- Do not use β-blockers (block compensatory tachycardia)
Disposition
Chronic
Acute
See Also
External Links
- emDocs - Acute Valvular Emergencies: Pearls and Pitfalls
- RECAP EM - Diagnosis and Management of Severe Aortic Regurgitation