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 Pathology||Electrocardiogram||Chest X-Ray||Bedside Ultrasound|
|Aortic stenosis||Left ventricular hypertrophy||Pulmonary edema||Thickened valves (possible)|
|Aortic regurgitation||Left ventricular hypertrophy||Pulmonary edema, possible wide mediastinum||Left ventricle dilation (possible)|
|Mitral stenosis||Atrial fibrillation||Pulmonary edema, pulmonary hypertension||Left atrium enlargement (possible)|
|Mitral regurgitation||Underlying pathology||Pulmonary edema, potentially unilateral||Left heart dilation or leaflet movement abnormality (possible)|
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
|Medication||Usual Dosing Range||Hemodynamic Effect|
|Norepinephrine||0.04-1 mcg/kg/min||↑CO, ↑↑SVR, ↑PCWP|
|Epinephrine||0.01-2 mcg/kg/min||↑↑CO, ↑SVR, ↑PCWP|
|Vasopressin||0.03 units/min||↓CO, ↑SVR, ↑PCWP|
|Phenylephrine||0.1-0.3 mcg/kg/min||↓CO, ↑SVR, ↑PCWP|
|Dopamine||>10 mcg/kg/min||↑CO, ↑SVR|
|Dobutamine||2.5-20 mcg/kg/min||↑↑CO, ↓⮂SVR, ↓⮂PCWP|
|Milrinone||0.125-0.75 mcg/kg/min||↑↑CO, ↓↓SVR, ↓↓PCWP|
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.
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
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.
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 January 25, 2023