Managing Acute Cardiac Valvular Emergencies in the Emergency Department

Managing Acute Cardiac Valvular Emergencies in the Emergency Department is organized by EB Medicine.

Date of Original Release: August 1, 2022
Termination Date: August 1, 2025

Description:
When patients present with complaints suspicious for acute coronary syndromes, tachycardia, heart failure, or COPD, it is important to consider a valvular cause. A thorough history and physical examination and targeted diagnostic studies can help narrow the differential. This issue reviews the evidence on the diagnosis and management of cardiac valve emergencies, including:

• The key physical examination findings that differentiate aortic valve disease from mitral valve disease.
• Whether the valvular dysfunction is new and acute, old and/or chronic, or comorbid with other cardiac or lung conditions.
• Interpreting important auscultation findings of murmur sounds, locations, and timing.
• Adding point-of-care bedside echocardiography to the laboratory, ECG, and x-ray findings to reveal clues to the etiology.
• Using vasoactive agents appropriately for the particular type of valvular dysfunction.
• When surgery, ECMO, LVADs, and intra-aortic balloon pumps are indicated and when they are not.
• Appropriate management of patients with prosthetic valves.

Needs Assessment: The need for this educational activity was determined by a practice gap analysis; a survey of medical staff, including the editorial board of this publication; review of morbidity and mortality data from the CDC, AHA, NCHS, and ACEP; and evaluation responses from prior educational activities for emergency physicians.

Goals: Upon completion of this activity, you should be able to: (1) identify areas in practice that require modification to be consistent with current evidence in order to improve competence and performance; (2) develop strategies to accurately diagnose and treat both common and critical ED presentations; and (3) demonstrate informed medical decision-making based on the strongest clinical evidence.

CME Objectives: Upon completion of this activity, you should be able to: (1) describe the etiologies of common cardiac valve diseases, including aortic stenosis, mitral stenosis, aortic regurgitation, and mitral regurgitation; (2) list the diagnostic studies required, based on patient history and physical examination; and (3) determine treatment of valvular emergencies based on staging and patient needs.