Aortic Regurgitation in Emergency Medicine Treatment & Management

  • Author: Jerry Balentine, DO; Chief Editor: David FM Brown, MD   more...
 
Updated: Dec 5, 2011
 

Emergency Department Care

  • General
    • Provide adequate airway management.
    • Intubate when necessary.
    • Consider prompt surgical intervention in acute aortic regurgitation.
  • Acute aortic regurgitation
    • Administer a positive inotrope (eg, dopamine, dobutamine) and a vasodilator (eg, nitroprusside). Rarely, administration of cardiac glycosides (eg, digoxin) for rate control may be necessary.
    • Avoid beta-blockers in the acute setting.
    • Administration of vasodilators may be appropriate to improve systolic function and to decrease afterload.
  • Chronic aortic regurgitation
    • Consider antibiotic prophylaxis for patients with endocarditis when performing procedures likely to result in bacteremia.
    • Administration of pressors and/or vasodilators may be appropriate.
  • Hemodynamically significant aortic regurgitation may require surgical intervention according to the following criteria:[7]
    • Cardiac-thoracic ratio >0.64
    • Fractional shortening < 25-29%
    • End-systolic diameter >55 mm
    • End-diastolic radius to myocardial wall thickness ratio >4.0
    • Ejection fraction < 0.45
    • Cardiac index < 2.2-2.5 L/min/m2
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Consultations

  • Cardiology
  • Cardiothoracic surgery
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Contributor Information and Disclosures
Author

Jerry Balentine, DO  Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St Barnabas Hospital

Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Eric C Appelbaum, DO  Associate Medical Director, Ambulatory Care, Associate Director, Emergency Department, St Barnabas Hospital, Bronx

Eric C Appelbaum, DO, is a member of the following medical societies: American College of Osteopathic Emergency Physicians, American College of Osteopathic Internists, and American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Suzanne White, MD  Medical Director, Regional Poison Control Center at Children's Hospital, Program Director of Medical Toxicology, Associate Professor, Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine

Suzanne White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Clinical Toxicology, American College of Epidemiology, American College of Medical Toxicology, American Medical Association, and Michigan State Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gary Setnik, MD  Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School

Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Management position; ProceduresConsult.com Royalty Other

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Elizabeth Kassapidis, DO, to the development and writing of this article.

References

  1. Saura D, Peñafiel P, Martínez J, de la Morena G, García-Alberola A, Soria F, et al. [The frequency of systolic aortic regurgitation and its relationship to heart failure in a consecutive series of patients]. Rev Esp Cardiol. Jul 2008;61(7):771-4. [Medline].

  2. Braunwald E. Heart Disease: A Textbook of Cardiovascular Medicine. 3rd ed. Philadelphia, Pa: Saunders; 1988.

  3. Babu AN, Kymes SM, Carpenter Fryer SM. Eponyms and the diagnosis of aortic regurgitation: what says the evidence?. Ann Intern Med. May 6 2003;138(9):736-42. [Medline].

  4. Giuliani E. Cardiology: Fundamentals and Practice. 2nd ed. Philadelphia, Pa: Mosby Year Book; 1991.

  5. Kloner R. The Guide to Cardiology. 2nd ed. New York: Le Jacq Communications; 1990.

  6. Lancellotti P, Tribouilloy C, Hagendorff A, Moura L, Popescu BA, Agricola E, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr. Apr 2010;11(3):223-44. [Medline].

  7. Sambola A, Tornos P, Ferreira-Gonzalez I, Evangelista A. Prognostic value of preoperative indexed end-systolic left ventricle diameter in the outcome after surgery in patients with chronic aortic regurgitation. Am Heart J. Jun 2008;155(6):1114-20. [Medline].

  8. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. Feb 16 2000;283(7):897-903. [Medline].

  9. Hwang MS, Chu JJ, Su WJ. Natural history and risk stratification of discrete subaortic stenosis in children: an echocardiographic study. J Formos Med Assoc. Jan 2004;103(1):17-22. [Medline].

  10. Tops LF, Kapadia SR, Tuzcu EM, Vahanian A, Alfieri O, Webb JG, et al. Percutaneous valve procedures: an update. Curr Probl Cardiol. Aug 2008;33(8):417-57. [Medline].

 
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