Pulmonary regurgitation medical therapy: Difference between revisions
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==Overview == | ==Overview == | ||
Treatment of pulmonic regurgitation may be divided into medical and surgical treatment. Medical management of pulmonic regurgitation may include use of diuretics in patients with RV dysfunction. ACE inhibitors and | Treatment of [[pulmonic regurgitation]] may be divided into medical and surgical treatment. Medical management of [[pulmonic regurgitation]] may include use of [[diuretics]] in patients with [[RV dysfunction]]. [[ACE inhibitors]] and [[beta blockers]] may be used to reverse neurohormonal activation and improve symptoms.<ref name="pmid12093776">{{cite journal| author=Bolger AP, Sharma R, Li W, Leenarts M, Kalra PR, Kemp M et al.| title=Neurohormonal activation and the chronic heart failure syndrome in adults with congenital heart disease. | journal=Circulation | year= 2002 | volume= 106 | issue= 1 | pages= 92-9 | pmid=12093776 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12093776 }} </ref><ref name="pmid12354712">{{cite journal| author=Davos CH, Davlouros PA, Wensel R, Francis D, Davies LC, Kilner PJ et al.| title=Global impairment of cardiac autonomic nervous activity late after repair of tetralogy of Fallot. | journal=Circulation | year= 2002 | volume= 106 | issue= 12 Suppl 1 | pages= I69-75 | pmid=12354712 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12354712 }} </ref> [[Antibiotic]] [[prophylaxis]] may be indicated in certain conditions such as patients with [[cyanotic heart disease]], [[prosthetic heart valves]], [[rheumatic heart disease]], and patients previously having sustained [[bacterial endocarditis]]. | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
*There are no specific medical measures for management of PR. | *There are no specific medical measures for management of PR. | ||
*Diuretics are recommended in patients with RV dysfunction for maintenance of fluid balance. | *[[Diuretics]] are recommended in patients with [[RV dysfunction]] for maintenance of fluid balance. | ||
*In patients with repaired [[Tetralogy of Fallot|tetralogy of fallot]], [[ACE inhibitor|ACE inhibitors]] or [[Beta blockers|beta-blockers]] are used to reverse the neuroharmonal activation and improve the symptoms.<ref name="pmid12093776">{{cite journal| author=Bolger AP, Sharma R, Li W, Leenarts M, Kalra PR, Kemp M et al.| title=Neurohormonal activation and the chronic heart failure syndrome in adults with congenital heart disease. | journal=Circulation | year= 2002 | volume= 106 | issue= 1 | pages= 92-9 | pmid=12093776 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12093776 }} </ref><ref name="pmid12354712">{{cite journal| author=Davos CH, Davlouros PA, Wensel R, Francis D, Davies LC, Kilner PJ et al.| title=Global impairment of cardiac autonomic nervous activity late after repair of tetralogy of Fallot. | journal=Circulation | year= 2002 | volume= 106 | issue= 12 Suppl 1 | pages= I69-75 | pmid=12354712 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12354712 }} </ref> | *In patients with repaired [[Tetralogy of Fallot|tetralogy of fallot]], [[ACE inhibitor|ACE inhibitors]] or [[Beta blockers|beta-blockers]] are used to reverse the neuroharmonal activation and improve the symptoms.<ref name="pmid12093776">{{cite journal| author=Bolger AP, Sharma R, Li W, Leenarts M, Kalra PR, Kemp M et al.| title=Neurohormonal activation and the chronic heart failure syndrome in adults with congenital heart disease. | journal=Circulation | year= 2002 | volume= 106 | issue= 1 | pages= 92-9 | pmid=12093776 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12093776 }} </ref><ref name="pmid12354712">{{cite journal| author=Davos CH, Davlouros PA, Wensel R, Francis D, Davies LC, Kilner PJ et al.| title=Global impairment of cardiac autonomic nervous activity late after repair of tetralogy of Fallot. | journal=Circulation | year= 2002 | volume= 106 | issue= 12 Suppl 1 | pages= I69-75 | pmid=12354712 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12354712 }} </ref> | ||
'''Antiobiotic prophylaxis''' | '''Antiobiotic prophylaxis''' | ||
The American Heart Association Recommendations on Prevention of [[Bacterial Endocarditis]] indicate that antibiotic prophylaxis is not necessary for pulmonic regurgitation in those patients with otherwise structurally normal pulmonic valves, particularly if there is no [[diastolic murmur]]. It should be noted, though, that those patients with the following conditions may warrant antibiotic prophylaxis:<ref name="pmid15201262">{{cite journal| author=Seiler C| title=Management and follow up of prosthetic heart valves. | journal=Heart | year= 2004 | volume= 90 | issue= 7 | pages= 818-24 | pmid=15201262 | doi=10.1136/hrt.2003.025049 | pmc=1768319 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15201262 }} </ref> | The [[American Heart Association]] Recommendations on Prevention of [[Bacterial Endocarditis]] indicate that [[antibiotic]] [[prophylaxis]] is not necessary for [[pulmonic regurgitation]] in those patients with otherwise structurally normal [[pulmonic valves]], particularly if there is no [[diastolic murmur]]. It should be noted, though, that those patients with the following conditions may warrant antibiotic prophylaxis:<ref name="pmid15201262">{{cite journal| author=Seiler C| title=Management and follow up of prosthetic heart valves. | journal=Heart | year= 2004 | volume= 90 | issue= 7 | pages= 818-24 | pmid=15201262 | doi=10.1136/hrt.2003.025049 | pmc=1768319 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15201262 }} </ref> | ||
#Complex [[cyanotic heart disease]] | #Complex [[cyanotic heart disease]] | ||
#[[Prosthetic heart valves]] | #[[Prosthetic heart valves]] | ||
#Patients with congenital heart disease and pulmonic regurgitation | #Patients with [[congenital heart disease]] and [[pulmonic regurgitation]] | ||
#Acquired pulmonic valve regurgitation as the result of [[rheumatic heart disease]] | #Acquired pulmonic valve regurgitation as the result of [[rheumatic heart disease]] | ||
#Patients with complex cyanotic heart disease | #Patients with complex [[cyanotic heart disease]] | ||
#In patients who have previously sustained [[bacterial endocarditis]] | #In patients who have previously sustained [[bacterial endocarditis]] | ||
Revision as of 16:26, 31 March 2017
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Pulmonic regurgitation Microchapters |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2], Aysha Anwar, M.B.B.S[3]
Overview
Treatment of pulmonic regurgitation may be divided into medical and surgical treatment. Medical management of pulmonic regurgitation may include use of diuretics in patients with RV dysfunction. ACE inhibitors and beta blockers may be used to reverse neurohormonal activation and improve symptoms.[1][2] Antibiotic prophylaxis may be indicated in certain conditions such as patients with cyanotic heart disease, prosthetic heart valves, rheumatic heart disease, and patients previously having sustained bacterial endocarditis.
Medical Therapy
- There are no specific medical measures for management of PR.
- Diuretics are recommended in patients with RV dysfunction for maintenance of fluid balance.
- In patients with repaired tetralogy of fallot, ACE inhibitors or beta-blockers are used to reverse the neuroharmonal activation and improve the symptoms.[1][2]
Antiobiotic prophylaxis
The American Heart Association Recommendations on Prevention of Bacterial Endocarditis indicate that antibiotic prophylaxis is not necessary for pulmonic regurgitation in those patients with otherwise structurally normal pulmonic valves, particularly if there is no diastolic murmur. It should be noted, though, that those patients with the following conditions may warrant antibiotic prophylaxis:[3]
- Complex cyanotic heart disease
- Prosthetic heart valves
- Patients with congenital heart disease and pulmonic regurgitation
- Acquired pulmonic valve regurgitation as the result of rheumatic heart disease
- Patients with complex cyanotic heart disease
- In patients who have previously sustained bacterial endocarditis
References
- ↑ 1.0 1.1 Bolger AP, Sharma R, Li W, Leenarts M, Kalra PR, Kemp M; et al. (2002). "Neurohormonal activation and the chronic heart failure syndrome in adults with congenital heart disease". Circulation. 106 (1): 92–9. PMID 12093776.
- ↑ 2.0 2.1 Davos CH, Davlouros PA, Wensel R, Francis D, Davies LC, Kilner PJ; et al. (2002). "Global impairment of cardiac autonomic nervous activity late after repair of tetralogy of Fallot". Circulation. 106 (12 Suppl 1): I69–75. PMID 12354712.
- ↑ Seiler C (2004). "Management and follow up of prosthetic heart valves". Heart. 90 (7): 818–24. doi:10.1136/hrt.2003.025049. PMC 1768319. PMID 15201262.