- 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
- myxomatous mitral valve disease with flail leaflet
- spontaneous chordal rupture
- AMI (papillary rupture, regional wall motion abnormality, LV dilation or dysfunction)
-> surgical emergency
-> revascularisation if induced by ischaemia
- rheumatic disease
- left atrial myxoma
- ball-valve thrombus
- annular calcification
-> conservative management often appropriate
-> balloon mitral valvotomy
-> if MR present may require urgent valve replacement
- spontaneous rupture of a congenital fenestration
- aortic dissection
-> surgical emergency (valve +/- root replacement)
- intercurrent illness
-> treat underlying problem
-> surgery never emergent
- chest trauma (blunt/penetrating)
- valve thrombosis (anti-coagulation, thrombolysis, surgery)
- paravalvular dehiscence (find cause and treat)
- leaflet tear
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.