Valvulopathy Findings and Medications

Adam Sigal, MD and Stephanie Costa, MD provided an excellent review of the Emergency Department Management of Patients with Cardiac Valve Emergencies in the August EMP article. Below are two table that appear in the article.


First is a table summarizing the diagnostic test findings for patients with valvulopathy:

Table 2. Diagnostic Testing Findings, Per Valvular Pathology

Murmur PathologyElectrocardiogramChest X-RayBedside Ultrasound
Aortic stenosisLeft ventricular hypertrophyPulmonary edemaThickened valves (possible)
Aortic regurgitationLeft ventricular hypertrophyPulmonary edema, possible wide mediastinumLeft ventricle dilation (possible)
Mitral stenosisAtrial fibrillationPulmonary edema, pulmonary hypertensionLeft atrium enlargement (possible)
Mitral regurgitationUnderlying pathologyPulmonary edema, potentially unilateralLeft heart dilation or leaflet movement abnormality (possible)
Source: Sigal A, Costa S. Managing acute cardiac valvular emergencies in the emergency department. Emerg Med Pract. 2022 Aug;24(8):1-24. Epub 2022 Aug 1. PMID: 35861568.

Second is a table detailing the effects of vasogenic medications in patients with cardiogenic shock due to valvulopathy.

Table 3. Vasoactive Medications for Cardiogenic Shock in Valvulopathy

MedicationUsual Dosing RangeHemodynamic Effect
Vasopressors
Norepinephrine0.04-1 mcg/kg/min↑CO, ↑↑SVR, ↑PCWP
Epinephrine0.01-2 mcg/kg/min↑↑CO, ↑SVR, ↑PCWP
Vasopressin0.03 units/min↓CO, ↑SVR, ↑PCWP
Phenylephrine0.1-0.3 mcg/kg/min↓CO, ↑SVR, ↑PCWP
Dopamine5-10 mcg/kg/min↑CO
Dopamine>10 mcg/kg/min↑CO, ↑SVR
Inotropes
Dobutamine2.5-20 mcg/kg/min↑↑CO, ↓⮂SVR, ↓⮂PCWP
Milrinone0.125-0.75 mcg/kg/min↑↑CO, ↓↓SVR, ↓↓PCWP
Abbreviations: CO, cardiac outout: PCWP, pulmonary capillary wedge pressure: SVR, systemic vascular resistance
Source: Sigal A, Costa S. Managing acute cardiac valvular emergencies in the emergency department. Emerg Med Pract. 2022 Aug;24(8):1-24. Epub 2022 Aug 1. PMID: 35861568.

Both tables contain a wealth of information that may be useful at the bedside when examining a patient with a suspected valvular emergency, or considering treatment for cariogenic shock.

Further Reading

Managing Acute Cardiac Valvular Emergencies in the Emergency Department

For patients presenting with syncope, dyspnea, edema, tachycardia, or chest pain, determining a potentially valvular origin is a key part of management. This issue reviews the signs, symptoms, and findings in aortic and mitral stenosis and regurgitation. Date Release: Aug 2022

Valvular Emergencies Podcast

EMplify August, 2022 Podcast episode: An Interview with Adam Sigal, MD and Stephanie Costa, MD – the authors of the August 2022 EMP article on Managing Acute Cardiac Valvular Emergencies in the Emergency Department. Listen to the discussion to hear more about the emergency medicine approach to valvular emergencies.


References

Sigal A, Costa S. Managing acute cardiac valvular emergencies in the emergency department. Emerg Med Pract. 2022 Aug;24(8):1-24. Epub 2022 Aug 1. PMID: 35861568.

Last Updated on August 9, 2022

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