Management of AR

In acute severe AR, secondary supportive management is needed while the underlying cause is being treated. Blood cultures should be taken unless there is an obvious underlying cause (e.g. Aortic dissection or AMI).

Any patient with known AR presenting in heart failure will need admission for evaluation and consideration of aortic valve replacement [7].

In an acute presentation of a patient with chronic AR, adjustment of medical therapies such as diuretics, vasodilators, rate and rhythm control is needed acutely.

Another management issue associated with AR is that AR patients have an increased risk of developing endocarditis and should receive appropriate antibiotic prophylaxis.

Emergency measures

The emergency measures required for AR are as follows:

• Contact specialist services as may need surgical intervention as an emergency
• In acute AR supportive measures are directed at reducing pulmonary venous pressure and increasing cardiac output. They will include the use of vasodilators, intubation and positive pressure ventilation
• Inotropic support may be needed but can worsen the AR
• Nitrates and diuretics have little effect and the intra-aortic balloon pump is contraindicated