Acute Valvular Emergencies

Author: Dr. Catherine Buckley

When I think of patients with valvular disease in the setting of the emergency department, it is frequently the acute on chronic picture. For instance: the Aortic stenosis patient with significant worsening of their fluid overload symptoms because of sepsis. What I typically don’t imagine is diagnosing or treating brand new valvular emergencies. Thank goodness for didactics! We are going to briefly review acute Mitral Regurgitation and acute Aortic regurgitation based on a wonderful talk given by Dr. Yelena Dukarevich. 

Wide Complex Tachycardia

Intro

There’s an old adage that wide complex tachycardia is VTach until proven otherwise. While this is true as do not want to miss any potentially lethal arrhythmia, it is also important to understand the differential for wide complex tachycardias so that we can tailor our potential treatments to the specific arrhythmia. It is also important to note that in any unstable patient with a wide complex tachycardia (or narrow complex tachycardia) that electricity is always safe.

Narrow Complex Tachycardias

Intro

The differential for narrow complex tachycardia is extremely important as it is the most commonly seen abnormal EKG in the emergency department. It includes rhythms such as sinus tachycardia, AVnRT, AVRT, atrial flutter, ectopic atrial tachycardia (EAT), atrial fibrillation, atrial flutter, and multifocal atrial tachycardia (MAT).

The goal of this blog is to run through this differential and give some methods to differentiate the rhythms. Although we will not delve too deep into antiarrhythmics, it is important to note that electricity is safe in all unstable rhythms no matter the etiology.