Valvular Emergencies
These vavular emergencies can hide easily; they are often diagnosed instead as sepsis, pneumonia or simple heart failure - Catherine Buckley MD
HWN Suggests
Acute Valvular Emergencies
When I think of patients with valvular disease in the setting of the emergency department, it is frequently the acute on chronic picture. For instance: the Aortic stenosis patient with significant worsening of their fluid overload symptoms because of sepsis. What I typically don’t imagine is diagnosing or treating brand new valvular emergencies. Thank goodness for didactics!
Articles of Interest
Acute Valve Disasters - Critical Aortic & Mitral Regurgitation
Think about the Valves - Acute structural heart disease, due to valvular disease or myocardial disruption, is a great masquerader presenting as unexplained dyspnea and hypotension in the setting of acute decompensated heart failure (ADHF) that often responds poorly to standard medical management.
Acute Valve Disasters Part 2 – Management of Critical Aortic Stenosis
AS without intervention can deteriorate to acute decompensated heart failure and cardiogenic shock due to either progressive valve and myocardial dysfunction or perhaps even more frequently, a superimposed disease process. Life expectancy is only 1-2 years after the development of symptoms of LV failure with only an 18% survival to 5 years.
Acute Valvular Emergencies: Pearls and Pitfalls
Though patients with clinically evident valvular heart disease have a 3.2-fold increase risk for stroke and 2.5-fold increase risk for death, most valvular heart disease encountered in the emergency department is chronic and does not require emergency stabilization. This is vastly different than the rare patient presenting with an acute valvular emergency. Symptoms of an acute valvular emergency may include dyspnea, tachycardia, pulmonary edema, and rapid development of cardiogenic shock. Many of these symptoms are seen with various other diagnoses, and the biggest pitfall clinicians may experience is leaving acute valvular emergency off the differential for patients presenting with acute dyspnea.
Managing Acute Cardiac Valvular Emergencies in the Emergency Department
Valvular heart disease is becoming more prevalent as the United States’ population ages, with aortic and mitral valves most commonly affected. Complications, including syncope, heart failure, dyspnea, and chest pain, can arise from slow progression of stenosis and regurgitation, though acute regurgitation from an ischemic or traumatic event can be life-threatening. Patients with valvular disease may present with cardiogenic shock, and vasoactive agent treatment will depend on determination of the valvular etiology.
