From the Guidelines
The most appropriate management for a patient with acute severe aortic regurgitation (AR) is urgent surgical intervention, as recommended by the American College of Cardiology/American Heart Association guidelines 1. This approach is based on the high mortality and morbidity associated with acute severe AR, even with intensive medical management. The use of medications such as nitroprusside, dopamine, or dobutamine may be helpful in temporarily managing the patient before surgery, but they are not a substitute for surgical intervention. Some key considerations in the management of acute severe AR include:
- The need for urgent surgical intervention, especially in patients with hypotension, pulmonary edema, or evidence of low output 1
- The potential benefits and risks of using beta blockers, which should be used cautiously, if at all, in the setting of acute AR 1
- The importance of individualizing treatment to the patient's unique circumstances, taking into account their medical history, current medications, and any diagnostic test results 1 In general, patient management should begin with a thorough assessment, followed by diagnosis and then a tailored treatment plan. This plan might include medications, lifestyle modifications, follow-up appointments, or referrals to specialists depending on the condition. The treatment should address both immediate symptoms and underlying causes while considering potential side effects, contraindications, and the patient's preferences.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management of Cardioembolic Stroke
- The most appropriate management of a patient with cardioembolic stroke involves a thorough diagnostic evaluation to determine the underlying cardioembolic cause of the stroke 2.
- Secondary stroke prevention strategies differ across various heterogeneous mechanisms, including atrial fibrillation, aortic arch atheroma, patent foramen ovale, and left ventricular dysfunction 2.
- Medical treatment advances, such as the use of direct oral anticoagulants in patients with atrial fibrillation, and surgical treatments like closure of patent foramen ovale, have been shown to reduce the risk of recurrent stroke in select patients 2.
Importance of Vital Signs Assessment
- The assessment of vital signs is critical for safe, high-quality care and provides valuable insight into the patient's condition, including their response to medical treatment 3.
- Abnormal vital signs have been associated with poor clinical outcomes, emphasizing the need for regular vital signs assessment 3.
Diagnostic Stewardship
- Diagnostic stewardship aims to promote timely and appropriate diagnostic testing that directly links to management decisions, discouraging excessive diagnostic testing in low-probability cases 4.
- A stewardship mindset can aid bedside clinicians in interpreting and incorporating new diagnostic strategies, ensuring safe, feasible, and effective patient outcomes 4.