Acute Mitral Regurgitation Medication
- Author: Daniel DiSandro, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...
The mainstay of treatment is preload and afterload reduction, particularly in the setting of mitral regurgitation with pulmonary edema.
These agents are used to reduce preload and the left ventricular volume.
An excellent preload reducer. Increases excretion of water by interfering with chloride-binding cotransport system, which, in turn, inhibits sodium and chloride reabsorption in ascending loop of Henle and distal renal tubule.
Dose must be individualized. Depending on response, administer at increments of 20-40 mg, no sooner than 6-8 h after the previous dose, until desired diuresis occurs. When treating infants, titrate with 1-mg/kg/dose increments until a satisfactory effect is achieved.
These agents are useful in preload reduction and as antianginal agents.
Causes relaxation of the vascular smooth muscle via stimulation of intracellular, cyclic guanosine monophosphate production, which causes a decrease in blood pressure.
DOC for afterload reduction. Has an effect on afterload reduction but also some effect on preload; produces vasodilation and increases inotropic activity of the heart. In addition, reduces peripheral resistance by directly acting on arteriolar and venous smooth muscle.
These agents are used for the control of atrial fibrillation in the setting of chronic mitral regurgitation.
DOC in rate control of atrial fibrillation. Cardiac glycoside with direct inotropic effects in addition to indirect effects on the cardiovascular system.
Useful as second line of therapy in rate control of atrial fibrillation and chronic mitral regurgitation. During the depolarization, it inhibits the calcium ion from entering the slow channels or the voltage-sensitive areas of the vascular smooth muscle and myocardium.
[Guideline] Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, et al. 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. J Am Coll Cardiol. 2008 Sep 23. 52(13):e1-142. [Medline]. [Full Text].
Borer JS, Bonow RO. Contemporary approach to aortic and mitral regurgitation. Circulation. 2003 Nov 18. 108(20):2432-8. [Medline].
Carabello BA. Management of valvular regurgitation. Curr Opin Cardiol. 1995 Mar. 10(2):124-7. [Medline].
Carabello BA. Mitral valve disease. Curr Probl Cardiol. 1993 Jul. 18(7):423-78. [Medline].
Fenster MS, Feldman MD. Mitral regurgitation: an overview. Curr Probl Cardiol. 1995 Apr. 20(4):193-280. [Medline].
Filsoufi F, Salzberg SP, Adams DH. Current management of ischemic mitral regurgitation. Mt Sinai J Med. 2005 Mar. 72(2):105-15. [Medline].
Gaasch WH, Eisenhauer AC. The management of mitral valve disease. Curr Opin Cardiol. 1996 Mar. 11(2):114-9. [Medline].
Schon HR. Medical treatment of chronic valvular regurgitation. J Heart Valve Dis. 1995 Oct. 4 Suppl 2:S170-4. [Medline].
Wisenbaugh T. Mitral valve disease. Curr Opin Cardiol. 1994 Mar. 9(2):146-51. [Medline].
Zito C, Manganaro R, Khandheria B, et al. Usefulness of left atrial reservoir size and left ventricular untwisting rate for predicting outcome in primary mitral regurgitation. Am J Cardiol. 2015 Oct 15. 116(8):1237-44. [Medline].
Arsalan M, Squiers JJ, DiMaio JM, Mack MJ. Catheter-based or surgical repair of the highest risk secondary mitral regurgitation patients. Ann Cardiothorac Surg. 2015 May. 4(3):278-83. [Medline].