ICU · Cardiovascular / valvular

Valvular Disease in the ICU

Also known as Valvular heart disease · Aortic stenosis · Aortic regurgitation · Mitral regurgitation · Mitral stenosis · TAVI · TAVR · Prosthetic valve · Valve thrombosis · Balloon mitral valvuloplasty · BMV · MitraClip · Papillary muscle rupture

Severe valvular disease in the ICU has valve-specific haemodynamic implications that determine what the patient can and cannot tolerate. Severe aortic stenosis (a stiff, hypertrophied LV) is preload-dependent and vasodilator-intolerant — avoid tachycardia, hypovolaemia, and vasodilation; use phenylephrine. Severe aortic and mitral regurgitation (volume overload) benefit from afterload reduction and a higher heart rate — use vasodilators and avoid bradycardia. Severe mitral stenosis (an obstructed inflow) needs rate control and avoids vasodilation. Maintain sinus rhythm in all (the atrial kick matters for the stiff or overloaded LV). Echocardiography is the diagnostic tool; the definitive treatment is surgical or percutaneous (AVR, TAVI/TAVR, MV repair, balloon mitral valvuloplasty). Prosthetic valves require lifelong anticoagulation (mechanical) and carry risks of thrombosis and infective endocarditis.