Emergent Valve Disorders
OVERVIEW
- regurgitation most common
- acute or acute on chronic valve dysfunction
- acute on chronic often precipitated by increase in metabolic or haemodynamic requirements (sepsis, bleeding, pregnancy).
- produce cardiogenic shock
CAUSES and MANAGEMENT
MR
- myxomatous mitral valve disease with flail leaflet
- spontaneous chordal rupture
- endocarditis
- AMI (papillary rupture, regional wall motion abnormality, LV dilation or dysfunction)
- Management
-> surgical emergency
-> IABP
-> revascularisation if induced by ischaemia
MS
- rheumatic disease
- left atrial myxoma
- ball-valve thrombus
- annular calcification
- SLE
- Management
-> conservative management often appropriate
-> balloon mitral valvotomy
-> if MR present may require urgent valve replacement
AR
- endocarditis
- spontaneous rupture of a congenital fenestration
- aortic dissection
- Management
-> surgical emergency (valve +/- root replacement)
AS
- intercurrent illness
- LVF
- MI
- Management
-> treat underlying problem
-> surgery never emergent
TR
- endocarditis
- chest trauma (blunt/penetrating)
Prosthetic valves
- endocarditis
- valve thrombosis (anti-coagulation, thrombolysis, surgery)
- paravalvular dehiscence (find cause and treat)
- leaflet tear
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC