Mitral regurgitation treatment overview: Difference between revisions

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Latest revision as of 23:29, 18 August 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S ; Lakshmi Gopalakrishnan, M.B.B.S

Overview

Vasodilator therapy with ACE inhibitors and hydralazine is the foundation of medical therapy and once the patient becomes symptomatic, mitral valve surgery is the definitive therapy. This chapter reviews general treatment measures for the patient with mitral regurgitation.

Afterload Reduction

Afterload reduction should be instituted with the use of vasodilators such as ACE inhibitors and hydralazine.

Diuretics

Diuretics are useful in reducing left ventricular volumes to improve functional mitral regurgitation and to improve pulmonary edema.

Digitalis

Digitalis may be used to strengthen contractility, and potentially reduce hospitalization in patients with congestive heart failure.

Diet

A low-sodium diet may be helpful.

Activity

Most patients with chronic compensated mitral regurgitation have no symptoms; but if a person develops symptoms, activity should be restricted.

Beta Blockers

Beta blockers are generally not recommended as they would slow the compensatory tachycardia and would allow greater time over which the regurgitation could occur and increase the regurgitant volume.

Calcium Channel Blockers

In the presence of atrial fibrillation, a calcium channel blocker or digoxin can be administered to slow the heart rate down and improve left ventricular filling.

Cardioversion

Cardioversion should be considered in the patient with atrial fibrillation or flutter who is hemodynamically unstable.

Anticoagulation

Anti-coagulation therapy should be considered in patients with atrial fibrillation and in patients with prosthetic mitral valve replacement surgery.

Antibiotic Prophylaxis

Prophylactic antibiotics prior to a periodontal procedure which involves manipulation of gingival tissue, the periapical region of a tooth, or perforation of oral mucosa is recommended in patients with previous infective endocarditis, patients who have a prosthetic mitral valve implanted and in those with congentital heart disease.^[1]

References

↑ Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT (2007). "Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group". Circulation. 116 (15): 1736–54. doi:10.1161/CIRCULATIONAHA.106.183095. PMID 17446442. Retrieved 2011-03-16. Unknown parameter |month= ignored (help)

Template:WikiDoc Sources

[pmid17446442-1] Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT (2007). "Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group". Circulation. 116 (15): 1736–54. doi:10.1161/CIRCULATIONAHA.106.183095. PMID 17446442. Retrieved 2011-03-16. Unknown parameter |month= ignored (help)

[1]

@@ Line 1: / Line 1: @@
-{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S ; [[Lakshmi Gopalakrishnan]], M.B.B.S
+__NOTOC__
+{| class="infobox" style="float:right;"
+|-
+| [[File:Siren.gif|30px|link=Mitral regurgitation resident survival guide]]|| <br> || <br>
+| [[Mitral regurgitation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
+|}
+{| class="infobox" style="float:right;"
+|-
+| [[File:Critical_Pathways.gif|88px|link=Mitral regurgitation critical pathways]]|| <br> || <br>
+|}
+{{Mitral regurgitation}}
+{{CMG}}; {{AE}} {{CZ}}; [[Varun Kumar]], M.B.B.S ; [[Lakshmi Gopalakrishnan]], M.B.B.S
 ==Overview==
-The choice of treatment depends on the symptoms present and the condition and function of the heart. Patients with high blood pressure or a weakened heart muscle may be given medications to reduce the strain on the heart and help improve the condition.
+Vasodilator therapy with [[ACE inhibitors]] and [[hydralazine]] is the foundation of medical therapy and once the patient becomes symptomatic, mitral valve surgery is the definitive therapy.  This chapter reviews general treatment measures for the patient with mitral regurgitation.
-[[Digitalis]] may be used to strengthen the heartbeat, along with [[diuretics]] (water pills) to remove excess fluid in the lungs.
+==Afterload Reduction==
+* Afterload reduction should be instituted with the use of [[vasodilators]] such as [[ACE inhibitors]] and [[hydralazine]].
-A low-sodium diet may be helpful. Most people have no symptoms; but if a person develops symptoms, activity may be restricted.
+==Diuretics==
+*Diuretics are useful in reducing left ventricular volumes to improve functional mitral regurgitation and to improve pulmonary edema.
-Hospitalization may be required for diagnosis and treatment of severe symptoms. Surgical repair or replacement of the valve is recommended if heart function is poor, symptoms are severe, or the condition gets worse. Once the diagnosis of mitral regurgitation is made, the patient should have regular follow-ups with a specialist to determine whether he or she need surgery.
+==Digitalis==
+*[[Digitalis]] may be used to strengthen contractility, and potentially reduce hospitalization in patients with congestive heart failure.
-* In patients with mitral regurgitation (acute or chronic) with hemodynamic instability, an electrocardiogram should be done to assess for the presence of [[Myocardial Infarction]]. In its absence, [[infective endocarditis]] should be excluded by drawing blood cultures and ordering an echocardiogram.
+==Diet==
+*A low-sodium diet may be helpful.
-* Afterload reduction should be instituted through the use of [[vasodilators]] such as [[ACE inhibitors]].
+==Activity==
+*Most patients with chronic compensated mitral regurgitation have no symptoms; but if a person develops symptoms, activity should be restricted.
-* In the presence of [[atrial fibrillation]], [[beta blocker]], [[calcium channel blocker]] or [[digoxin]] can be administered to slow the heart rate down and improve left ventricular filling.
+==Beta Blockers==
+Beta blockers are generally not recommended as they would slow the compensatory tachycardia and would allow greater time over which the regurgitation could occur and increase the regurgitant volume.
+==Calcium Channel Blockers==
+* In the presence of [[atrial fibrillation]], a [[calcium channel blocker]] or [[digoxin]] can be administered to slow the heart rate down and improve left ventricular filling.
+==Cardioversion==
+Cardioversion should be considered in the patient with atrial fibrillation or flutter who is hemodynamically unstable.
+==Anticoagulation==
 * Anti-coagulation therapy should be considered in patients with [[atrial fibrillation]] and in patients with prosthetic [[mitral valve replacement]] surgery.
+==Antibiotic Prophylaxis==
 * Prophylactic antibiotics prior to a periodontal procedure which involves manipulation of gingival tissue, the periapical region of a tooth, or perforation of oral mucosa is recommended in patients with previous infective endocarditis, patients who have a prosthetic mitral valve implanted and in those with congentital heart disease.<ref name="pmid17446442">{{cite journal |author=Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT |title=Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group |journal=[[Circulation]] |volume=116 |issue=15 |pages=1736–54 |year=2007 |month=October |pmid=17446442 |doi=10.1161/CIRCULATIONAHA.106.183095 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=17446442 |accessdate=2011-03-16}}</ref>
-*Based on age of patient, co-morbidities, symptoms and severity of mitral regurgitation, risks and benefits of valve surgery should be considered.
 ==References==
@@ Line 27: / Line 50: @@
 [[Category:Valvular heart disease]]
 [[Category:Cardiology]]
+[[Category:Disease]]
+[[Category:Cardiac surgery]]
 [[Category:Surgery]]
-[[Category:Cardiac surgery]]
 [[Category:Overview complete]]
-[[Category:Template complete]]
-[[Category:Disease state]]
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