Pulmonary regurgitation medical therapy: Difference between revisions

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===Anticoagulation===
===Anticoagulation===
*Administration of systemic [[anticoagulation]] has led to risk reduction of major [[thromboembolic]] events among [[patients]] with [[mechanical valves]]. The risks reduced from 23 per 100 patient-years to<ref name="pmid8313552">{{cite journal |vauthors=Cannegieter SC, Rosendaal FR, Briët E |title=Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses |journal=Circulation |volume=89 |issue=2 |pages=635–41 |date=February 1994 |pmid=8313552 |doi=10.1161/01.cir.89.2.635 |url=}}</ref>:
*Administration of systemic [[anticoagulation]] has led to risk reduction of major [[thromboembolic]] events among [[patients]] with [[mechanical valves]]. The risks reduced from 23 per 100 patient-years to<ref name="pmid8313552">{{cite journal |vauthors=Cannegieter SC, Rosendaal FR, Briët E |title=Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses |journal=Circulation |volume=89 |issue=2 |pages=635–41 |date=February 1994 |pmid=8313552 |doi=10.1161/01.cir.89.2.635 |url=}}</ref>:
** 2.2 per 100 patient-years with [[antiplatelet therapy]]
** 2.2 per 100 patient-years with [[Antiplatelet drug|antiplatelet therapy]]
** 1 per 100 patient-years with [[warfarin]]
** 1 per 100 patient-years with [[warfarin]]
*Among [[patients]] [[NYHA functional classification]] I or II and a small prosthetic clot, short-term [[IV]] [[unfractionated heparin]] or continuous [[fibrinolytic therapy]] can be administered.<ref name="pmid18820172">{{cite journal |vauthors=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 |date=October 2008 |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>
*Among [[patients]] [[New york heart association functional classification|NYHA functional class]] I or II and a small prosthetic clot, short-term [[IV]] [[unfractionated heparin]] or continuous [[fibrinolytic therapy]] can be administered.<ref name="pmid18820172">{{cite journal |vauthors=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 |date=October 2008 |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>
*The treatment of choice for obstructive [[thrombosis]] among [[critically ill]] [[patients]] without serious [[comorbidity]] is urgent [[valve]] replacement. (European Society of Cardiology guidelines)<ref name="pmid17259184">{{cite journal |vauthors=Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, Flachskampf F, Hall R, Iung B, Kasprzak J, Nataf P, Tornos P, Torracca L, Wenink A |title=Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology |journal=Eur. Heart J. |volume=28 |issue=2 |pages=230–68 |date=January 2007 |pmid=17259184 |doi=10.1093/eurheartj/ehl428 |url=}}</ref>
*The [[treatment]] of choice for obstructive [[thrombosis]] among [[critically ill]] [[patients]] without serious [[comorbidity]] is urgent [[valve]] replacement. (European Society of Cardiology guidelines)<ref name="pmid17259184">{{cite journal |vauthors=Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, Flachskampf F, Hall R, Iung B, Kasprzak J, Nataf P, Tornos P, Torracca L, Wenink A |title=Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology |journal=Eur. Heart J. |volume=28 |issue=2 |pages=230–68 |date=January 2007 |pmid=17259184 |doi=10.1093/eurheartj/ehl428 |url=}}</ref>
 
===Antiobiotic prophylaxis===
===Antiobiotic prophylaxis===



Latest revision as of 09:23, 9 August 2020

Pulmonic regurgitation Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differential diagnosis

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Chest X-Ray

Echocardiography

Cardiac MRI

Severity Assessment

Treatment

Medical Therapy

Surgical therapy

Follow up

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], Javaria Anwer M.D.[4]

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. 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. Among patients with carcinoid heart disease subcutaneously administered octreotide in 2–4 divided doses (50–1500 μg/day) provides symptomatic and biochemical benefit.

Medical Therapy

Anticoagulation

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:[7]

  1. Complex cyanotic heart disease
  2. Prosthetic heart valves
  3. Patients with congenital heart disease and pulmonic regurgitation
  4. Acquired pulmonic valve regurgitation as the result of rheumatic heart disease
  5. Patients with complex cyanotic heart disease
  6. In patients who have previously sustained bacterial endocarditis

Heart failure therapy

Carcinoid heart disease[11][12]

Subcutaneously administered octreotide in 2–4 divided doses (50–1500 μg/day) provides symptomatic and biochemical benefit. Octreotide (somatostatin analog) binds to somatostatin receptors, and reduces the vasoactive peptides that provoke carcinoid syndrome. Concomitant monitoring of BSL and blood glucose levels is required. Lanreotide (BIM23014, angiopeptin and somatuline) is a newer somatostatin analog, has an advantage of less frequent administrations, and can be used as an alternative to octreotide.

References

  1. Fauci, Anthony (2008). Harrison's principles of internal medicine. New York: McGraw-Hill Medical. ISBN 978-0071466332.
  2. 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.
  3. 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.
  4. Cannegieter SC, Rosendaal FR, Briët E (February 1994). "Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses". Circulation. 89 (2): 635–41. doi:10.1161/01.cir.89.2.635. PMID 8313552.
  5. 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 (October 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.
  6. Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, Flachskampf F, Hall R, Iung B, Kasprzak J, Nataf P, Tornos P, Torracca L, Wenink A (January 2007). "Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology". Eur. Heart J. 28 (2): 230–68. doi:10.1093/eurheartj/ehl428. PMID 17259184.
  7. 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.
  8. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT (October 2007). "Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group". Circulation. 116 (15): 1736–54. doi:10.1161/CIRCULATIONAHA.106.183095. PMID 17446442.
  9. Wald RM, Adatia I, Van Arsdell GS, Hornberger LK (September 2005). "Relation of limiting ductal patency to survival in neonatal Ebstein's anomaly". Am. J. Cardiol. 96 (6): 851–6. doi:10.1016/j.amjcard.2005.05.035. PMID 16169376.
  10. Chaturvedi RR, Redington AN (July 2007). "Pulmonary regurgitation in congenital heart disease". Heart. 93 (7): 880–9. doi:10.1136/hrt.2005.075234. PMC 1994453. PMID 17569817.
  11. 11.0 11.1 Fox DJ, Khattar RS (October 2004). "Carcinoid heart disease: presentation, diagnosis, and management". Heart. 90 (10): 1224–8. doi:10.1136/hrt.2004.040329. PMC 1768473. PMID 15367531.
  12. Janmohamed S, Bloom SR (April 1997). "Carcinoid tumours". Postgrad Med J. 73 (858): 207–14. doi:10.1136/pgmj.73.858.207. PMC 2431281. PMID 9156122.

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