Valvular heart disease: clinical approach to acute decompensation of left-sided lesions

Acute valvular heart disease is often life-threatening. The diagnosis of acute valvular decompensation is made by attention to the physical assessment and appropriate use of diagnostic techniques. Recent advances in valvular heart disease have centered around noninvasive diagnostics. Doppler echocardiography can accurately diagnose and quantify stenotic and regurgitant lesions; its use with M-mode and two-dimensional echocardiography makes these the noninvasive diagnostic procedures of choice. Acute decompensation is often related to preexisting critical aortic or mitral stenosis, or more commonly, acute severe regurgitation. Although of different etiologies, acute mitral and aortic regurgitation are associated with similar diagnostic and therapeutic modalities. Emergency treatment consists of vasodilator and, possibly, inotropic therapy. However, definitive therapy generally requires surgical intervention.