Acute aortic regurgitation medical therapy: Difference between revisions

Jump to navigation Jump to search
Line 15: Line 15:
*In [[patients]] with acute severe [[AR]] resulting from [[infectious endocarditis]] or [[aortic dissection]], reduction  [[LV]] afterload by [[medications]] may be a temporary stabilization, but [[surgery]] should not be delayed, especially in the presence of [[hypotension]], [[pulmonary edema]], or evidence of [[low flow]].
*In [[patients]] with acute severe [[AR]] resulting from [[infectious endocarditis]] or [[aortic dissection]], reduction  [[LV]] afterload by [[medications]] may be a temporary stabilization, but [[surgery]] should not be delayed, especially in the presence of [[hypotension]], [[pulmonary edema]], or evidence of [[low flow]].
* [[Intra-aortic balloon counterpulsation]] is contraindicated in [[patients]] with acute severe [[AR]].
* [[Intra-aortic balloon counterpulsation]] is contraindicated in [[patients]] with acute severe [[AR]].
* [[Beta blockers ]] are often used in treating [[aortic dissection]]. However, these agents should be used very cautiously because of block the compensatory [[tachycardia]] and reduction in [[blood pressure]].
* [[Beta blockers ]] are often used in treating [[aortic dissection]]. However, these agents should be used very cautiously because of block the compensatory [[tachycardia]] and reduction in [[blood pressure]].<ref name="pmid33332149">{{cite journal |vauthors=Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C |title=2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines |journal=Circulation |volume=143 |issue=5 |pages=e35–e71 |date=February 2021 |pmid=33332149 |doi=10.1161/CIR.0000000000000932 |url=}}</ref>
<ref name="pmid33332149">{{cite journal |vauthors=Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C |title=2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines |journal=Circulation |volume=143 |issue=5 |pages=e35–e71 |date=February 2021 |pmid=33332149 |doi=10.1161/CIR.0000000000000932 |url=}}</ref>


==Therapeutic Options==
==Therapeutic Options==

Revision as of 14:29, 21 July 2022



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; Usama Talib, BSc, MD [2]

Overview

In patients with acute severe AR resulting from infectious endocarditis or aortic dissection, reduction LV afterload by medications may be a temporary stabilization, but surgery should not be delayed, especially in the presence of hypotension, pulmonary edema, or evidence of low flow. Intra-aortic balloon counterpulsation is contraindicated in patients with acute severe AR. Beta blockers are often used in treating aortic dissection. However, these agents should be used very cautiously because of block the compensatory tachycardia and reduction in blood pressure.

Medical Therapy

Therapeutic Options

Nitroprusside

Nitroprusside lowers afterload and thereby reduces retrograde flow and left ventricular end diastolic pressure.[2]

Inotropic Agents

Inotropic agents such as dopamine and dobutamine can be used to increase the contractility of the heart resulting in improved forward flow.[3]

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.[2]

Intraaortic Balloon Pump

Insertion of an intraaortic balloon pump is contraindicated in acute AR, as it may worsen the severity of the regurgitation.[4]

Reference

  1. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C (February 2021). "2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 143 (5): e35–e71. doi:10.1161/CIR.0000000000000932. PMID 33332149 Check |pmid= value (help).
  2. 2.0 2.1 Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC guideline 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". J Am Coll Cardiol. 63 (22): e57–185. doi:10.1016/j.jacc.2014.02.536. PMID 24603191.
  3. 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)
  4. Rius JB, Mercè AS, del Blanco BG, Aguasca GM, Mas PT, García-Dorado García D (2011). "Resolution of shock-induced aortic regurgitation with an intraaortic balloon pump". Circulation. 124 (4): e131. doi:10.1161/CIRCULATIONAHA.111.038653. PMID 21788594.

Template:WH Template:WS CME Category::Cardiology