Acute aortic regurgitation medical therapy: Difference between revisions
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Revision as of 14:45, 6 January 2015
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Aortic Regurgitation Microchapters |
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Diagnosis |
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Treatment |
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Acute Aortic regurgitation |
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Chronic Aortic regurgitation |
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Special Scenarios |
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Case Studies |
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Acute aortic regurgitation medical therapy On the Web |
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American Roentgen Ray Society Images of Acute aortic regurgitation medical therapy |
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Risk calculators and risk factors for Acute aortic regurgitation medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Patients with acute severe aortic insufficiency are usually managed with emergency aortic valve replacement or repair. However, they can be stabilized medically before surgery with vasodilators.
Medical Therapy
Acute AR
In case cardiogenic shock is present in a patient with acute AR, resuscitation measures should be initiated immediately:
- Secure airway
- Administer oxygen
- Secure wide bore IV access
- Perform ECG monitor
- Monitor vitals continuously
- Admit to ICU
Medical therapy to treat cardiogenic shock should be immediately initiated:
- Administer nitroprusside 0.3-0.5 υg/kg/min IV (max 10 υg/kg/min), AND
- Administer dobutamine 0.5 υg/kg/min IV (max 20 υg/kg/min)
- Titrate to maintain mean arterial pressure (MAP) > 60 mmHg
- Administer beta blockers in high suspicion of aortic dissection. Do not use beta blockers for other causes as they will block the compensatory tachycardia.
Chronic AR
Therapeutic Options
Nitroprusside
Nitroprusside lowers afterload and thereby reduces retrograde flow and left ventricular end diastolic pressure.
Inotropic Agents
Inotropic agents such as dopamine and dobutamine can be used to increase the contractility of the heart resulting in improved forward flow.[1]
Beta Blockers
Beta blockers which are often used in managing aortic dissection should be used very cautiously in the presence of acute aortic insufficiency as beta blockers can block the compensatory tachycardia and worsen the cardiac output.
Antibiotics
Patients who are hemodynamically stable with mild aortic insufficiency secondary to infective endocarditis can be managed with antibiotics alone.
Intraaortic Balloon Pump
Insertion of an intraaortic balloon pump is contraindicated in the treatment of aortic insufficiency, as it may worsen the severity of the regurgitation.
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Diseases (DO NOT EDIT)[2]
Medical Therapy
| Class I |
| "1. Treatment of hypertension (systolic BP >140 mm Hg) is recommended in patients with chronic AR (stages B and C), preferably with dihydropyridine calcium channel blockers or ACE inhibitors/ARBs. (Level of Evidence: B)" |
| Class IIa |
| "1. Medical therapy with ACE inhibitors/ARBs and beta blockers is reasonable in patients with severe AR who have symptoms and/or LV dysfunction (stages C2 and D) when surgery is not performed because of comorbidities. (Level of Evidence: B)" |
Reference
- ↑ Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Retrieved 2011-04-07. Unknown parameter
|month=ignored (help) - ↑ "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.