Diagnosis and Management of Valvular Heart Disease in Emergency Medicine - 30/10/11

Doi : 10.1016/j.emc.2011.08.001

Richard S. Chen, MD, MBA ^a, Matthew J. Bivens, MD ^a, Shamai A. Grossman, MD, MS ^b,^c,^⁎
^a Harvard-Affiliated Emergency Medicine Residency, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, West Campus Clinical Center, Boston, MA 02215, USA
^b Clinical Decision Unit and Cardiac Emergency Center, Beth Israel Deaconess Medical Center, Boston, MA, USA
^c Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Road, Boston, MA 02215, USA

Corresponding author. Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Road, Boston, MA 02215.

Résumé

A popular saying holds that if one can hear a heart murmur in the middle of a loud and busy emergency department, then by definition the murmur is significant. Whether or not this is actually true, it does capture the frustration emergency physicians feel when trying to diagnose or manage valvular pathologic conditions with familiar yet limited tools. This article focuses on the valve-related issues the emergency physician will face, from the trauma patient with a mechanical valve who may need his or her anticoagulation reversed to the febrile patient with a new murmur.

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Keywords : Heart murmur, Mechanical valve, Endocarditis, Aortic stenosis, Mitral regurgitation