Acute aortic regurgitation medical therapy: Difference between revisions

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===Inotropic Agents===
===Inotropic Agents===
Inotropic agents such as [[dopamine]] and [[dobutamine]] can be used to increase the contractility of the [[heart]] resulting in improved forward flow.<ref name="pmid18820172">{{cite journal |author=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 |title=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 |journal=[[Circulation]] |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18820172 |accessdate=2011-04-07}}</ref>
Inotropic agents such as [[dopamine]] and [[dobutamine]] can be used to increase the contractility of the [[heart]] resulting in improved forward flow.<ref name="pmid29340539">{{cite journal |vauthors=Dubin A, Lattanzio B, Gatti L |title=The spectrum of cardiovascular effects of dobutamine - from healthy subjects to septic shock patients |language=Portuguese |journal=Rev Bras Ter Intensiva |volume=29 |issue=4 |pages=490–498 |date=2017 |pmid=29340539 |pmc=5764562 |doi=10.5935/0103-507X.20170068 |url=}}</ref>
 
===Beta Blockers===
===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]].<ref name="pmid24603191">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=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. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 22 | pages= e57-185 | pmid=24603191 | doi=10.1016/j.jacc.2014.02.536 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24603191  }} </ref>
[[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]].<ref name="pmid24603191">{{cite journal| author=Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al.| title=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. | journal=J Am Coll Cardiol | year= 2014 | volume= 63 | issue= 22 | pages= e57-185 | pmid=24603191 | doi=10.1016/j.jacc.2014.02.536 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24603191  }} </ref>

Revision as of 14:33, 21 July 2022



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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.[4]

Intraaortic Balloon Pump

Insertion of an intraaortic balloon pump is contraindicated in acute AR, as it may worsen the severity of the regurgitation.[5]

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. Miller RR, Vismara LA, DeMaria AN, Salel AF, Mason DT (November 1976). "Afterload reduction therapy with nitroprusside in severe aortic regurgitation: improved cardiac performance and reduced regurgitant volume". Am J Cardiol. 38 (5): 564–7. doi:10.1016/s0002-9149(76)80003-3. PMID 983953.
  3. Dubin A, Lattanzio B, Gatti L (2017). "The spectrum of cardiovascular effects of dobutamine - from healthy subjects to septic shock patients". Rev Bras Ter Intensiva (in Portuguese). 29 (4): 490–498. doi:10.5935/0103-507X.20170068. PMC 5764562. PMID 29340539.
  4. 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.
  5. 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.

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