Valvular Heart Disease, Emergency Medicine

Liudvikas Jagminas Reviewed 06/2017
 


Basics

Description

  • Mitral stenosis:

    • Obstruction of diastolic blood flow into the left ventricle (LV)

  • Mitral regurgitation:

    • Inadequate closure of the leaflets allows retrograde blood flow into the left atr...

Diagnosis

Signs and Symptoms

  • Mitral stenosis:

    • Malar flush (“mitral facies”)

    • Prominent jugular A-waves

    • Right ventricular lift

    • Loud S1

    • Opening snap

    • Low-pitched diastolic rumble

    • Exertional dyspnea

    • Fatigue

    • Palpitat...

Treatment

Pre-Hospital

Avoid vasodilators in aortic stenosis. 

Initial Stabilization/Therapy

  • ABCs

  • Administer oxygen.

  • Monitor and measure pulse oximetry.

  • IV access

Ed Treatment/Procedures

  • Mitral stenosis:

    • Treat...

Follow-Up

Disposition

Admission Criteria

  • New-onset atrial fibrillation

  • CHF/pulmonary edema

  • Hemodynamically unstable

  • Acute mitral or aortic regurgitation

  • Cardiac ischemia

  • Angina

  • Syncope

  • Arrhythmias

Discharge Criteria

Pearls and Pitfalls

In patients with chest pain and aortic stenosis, nitrates are contraindicated. 

Additional Reading

  • Bonow  RO, Cheitlin  MD, Crawford  MH, et al. Task Force 3: Valvular heart disease. J Am Coll Cardiol.  2005;45(8):1334–1340.

  • Carabello  BA, Crawford  FA. Valvular heart disease...

Codes

ICD9

  • 394.0 Mitral stenosis

  • 424.0 Mitral valve disorders

  • 424.90 Endocarditis, valve unspecified, unspecified cause

  • 395.0 Rheumatic aortic stenosis

  • 429.5 Rupture of chordae tendineae

  • 429.6 Rupture of pa...

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