Acute aortic regurgitation medical therapy: Difference between revisions

Jump to navigation Jump to search
m (Bot: Adding CME Category::Cardiology)
Line 41: Line 41:


===Medical Therapy===
===Medical Therapy===
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''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 angiotensin converting enzyme (ACE) inhibitors/angiotensin-receptor blockers (ARBs).''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|}


{|class="wikitable"
{|class="wikitable"

Revision as of 21:00, 4 January 2017



Resident
Survival
Guide

Aortic Regurgitation Microchapters

Home

Patient Information

Overview

Historical Pesrpective

Pathophysiology

Causes

Stages

Differentiating Aortic Regurgitation from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Cardiac Stress Test

Electrocardiogram

Chest X Ray

Echocardiography

Cardiac MRI

Treatment

Acute Aortic regurgitation

Medical Therapy
Surgery

Chronic Aortic regurgitation

Medical Therapy
Surgery

Precautions and Prophylaxis

Special Scenarios

Pregnancy
Elderly
Young Adults
End-stage Renal Disease

Case Studies

Case #1

Acute aortic regurgitation medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Acute aortic regurgitation medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Acute aortic regurgitation medical therapy

CDC on Acute aortic regurgitation medical therapy

Acute aortic regurgitation medical therapy in the news

Blogs on Acute aortic regurgitation medical therapy

Directions to Hospitals Treating Aortic regurgitation

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 regurgitation (AR) are managed with emergency aortic valve replacement or repair. Medical therapy is used for the stabilization of patients prior to surgery.

Medical Therapy

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.

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 AR as beta blockers can block the compensatory tachycardia and worsen the cardiac output.

Antibiotics

Patients who are hemodynamically stable with mild AR 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 AR, 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 angiotensin converting enzyme (ACE) inhibitors/angiotensin-receptor blockers (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

  1. 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)
  2. "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.

Template:WH Template:WS CME Category::Cardiology