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Additional info for First Aid for the Emergency Medicine Boards Third Edition
ETIOLOGIES ■ CARDIOVASC U LAR E M E RG E NC I ES ■ Acute mitral regurgitation ■ Endocarditis ■ Myocardial infarction ■ Trauma power mitral regurgitation ■ Rheumatic middle illness is commonest. ■ different factors comprise mitral valve prolapse, connective tissue issues. PATHOPHYSIOLOGY ■ ■ Acute harm or disorder of the valve, papillary muscle, or chordae tendinae → acute valve failure → acute left atrial overload and pulmonary edema. continual valve failure → compensatory dilation of left atrium and sluggish onset of CHF. ACUTE MITRAL REGURGITATION indicators ■ ■ ■ ■ Abrupt onset of dyspnea, tachypnea Cardiogenic surprise Chest ache signs of underlying disorder technique (endocarditis, MI, trauma) examination ■ ■ ■ Loud holosystolic murmur heard top on the apex, with radiation to the bottom Left ventricular heave Pulmonary edema prognosis ■ ■ Acute mitral regurgitation? deal with with nitroprusside, remedy ■ ■ dobutamine (if hypotensive), ■ and intra-aortic balloon pump ■ until eventually OR is obtainable. ECG: Absence of left atrial growth and LVH CXR: general cardiac silhouette, pulmonary edema ■ ■ typical remedy for pulmonary edema Nitroprusside for afterload relief Dobutamine (in addition to nitroprusside) if hypotensive Intra-aortic balloon pump as bridge to surgical procedure rapid valve alternative deal with underlying affliction technique. problems ■ ■ Acute pulmonary edema Cardiogenic surprise one hundred ten CHRONIC MITRAL REGURGITATION signs ■ ■ ■ frequently asymptomatic slow development of dyspnea Palpitations (from atrial ﬁbrillation) examination ■ ■ Holosystolic murmur heard most sensible on the apex with radiation to the bottom S3 middle sound ■ ■ ECG: Left atrial expansion, LVH, atrial ﬁbrillation (common) CXR: CHF in complicated circumstances remedy ■ ■ ■ ■ deal with CHF and atrial ﬁbrillation (consider anticoagulation). Anticoagulate if systemic embolization happens. Endocarditis prophylaxis Valve substitute Atrial ﬁbrillation and systemic emboli are universal in power problems ■ ■ ■ mitral regurgitation. Atrial ﬁbrillation (very universal) Systemic emboli from left atrial thrombus Endocarditis Mitral Valve Prolapse this can be essentially the most universal valvular problems. The prototypical sufferer is a tender, skinny woman. the precise etiology is unknown, yet is probably going congenital. linked to nervousness, consuming problems, panic assaults. PATHOPHYSIOLOGY ■ Myxomatous proliferation of valve leaﬂet → irregular stretching of valve leaﬂets in the course of systole. signs ■ ■ ■ ■ ■ often asymptomatic odd chest soreness Palpitations Lightheadedness Dyspnea In mitral valve prolapse, lowering the LV quantity will intensify the press and flow examination ■ it in the direction of S1. Early to midsystolic click on with high-pitched past due systolic murmur heard most sensible at left lateral middle border. ■ lowering the LV quantity (standing, Valsalva maneuver) → prior and larger prolapse → accentuates the clicking and strikes it toward S1.. 111 CARDIOVASC U LAR E M E RG E NC I ES analysis DIAGNOSIS ■ ■ ■ ECG: Nonspeciﬁc ST-T wave adjustments, paroxysmal supraventricular tachycardia (PSVT) CXR: No speciﬁc ﬁndings Echo: Conﬁrmatory therapy ■ ■ ■ No therapy if asymptomatic Prophylaxis for endocarditis if regurgitation or thickened valve leaﬂets β-Blockers can assist with bizarre chest soreness.