CVICU Flashcards
Acutely decompensated Aortic regurgitation can be treated with?
This patient has acutely decompensated aortic regurgitation and decompensated heart failure caused by endocarditis. Acutely decompensated aortic regurgitation necessitates emergent surgical intervention. This is because the heart has not had time to develop compensatory eccentric and concentric hypertrophy, as seen in chronic aortic regurgitation. In acute aortic regurgitation, the sudden increase in diastolic return from the aorta into the left ventricle results in left ventricular dilation, pulmonary edema, ventricular arrhythmias, and cardiovascular collapse. If there is a delay in surgery, temporary stabilization with intravenous vasodilators, such as nitroprusside, and inotropic agents, such as dobutamine, is required. Nitroprusside will improve forward flow (cardiac output) and lower the left ventricular diastolic pressure and pulmonary venous pressure by decreasing afterload. Dobutamine will increase myocardial contractility and improve cardiac output. It is important to distinguish between the different murmurs both during your test and while on the wards.
Acute aortic regurgitation would present with what finding that should constitute an emergent surgical consultation?
A new, early, diastolic decrescendo murmur on examination would be consistent with acute aortic regurgitation due to widening of the aortic root in the setting of a proximally propagating dissection flap and constitutes a surgical emergency.
