Valvular Heart Disease Emergencies: A Comprehensive Review Focusing on the Initial Approach in the Emergency Department

Abstract Valvular heart disease (VHD) is an increasing health problem worldwide. Patients with VHD may experience several cardiovascular-related emergencies. The management of these patients is a challenge in the emergency department, especially when the previous heart condition is unknown. Specific recommendations for the initial management are currently poor. This integrative review proposes an evidence-based three-step approach from bedside VHD suspicion to the initial treatment of the emergencies. The first step is the suspicion of underlying valvular condition based on signs and symptoms. The second step comprises the attempt to confirm the diagnosis and assessment of VHD severity with complementary tests. Finally, the third step addresses the diagnosis and treatment options for heart failure, atrial fibrillation, valvular thrombosis, acute rheumatic fever, and infective endocarditis. In addition, several images of complementary tests and summary tables are provided for physician support.

摘要：瓣膜性心脏病（Valvular Heart Disease, VHD）已成为全球范围内日益严峻的健康问题。该类患者可能罹患多种心血管相关急症，此类患者的急诊处置是急诊科面临的一大挑战，尤其当患者既往心脏病史不明时，临床初始救治的专属推荐方案尚且匮乏。本综合综述提出了一套基于循证医学的三步诊疗流程，覆盖从床旁疑似VHD诊断到急症初始救治的全环节：第一步为基于体征与症状疑似潜在瓣膜病变；第二步为通过辅助检查明确诊断并评估VHD严重程度；最后，第三步针对心力衰竭、心房颤动、瓣膜血栓形成、急性风湿热及感染性心内膜炎的诊疗选择进行阐述。此外，本文还配套提供了多幅辅助检查影像及汇总表格，以辅助临床医师开展工作。