Approach to the Critical Patient

Immediate priorities

Airway and ventilation threats

Circulation and shock threats

Monitoring and targets

Hemodynamic monitoring

Escalation triggers and consults

Surgical and specialist consults

History

Presentation pattern

Core presenting syndrome

Etiologic context

Ischemic etiology clues

Infectious etiology clues

Structural or myxomatous etiology

Risk factors

Papillary muscle rupture risk

Endocarditis risk

Other structural causes

Physical Exam

Vitals and general appearance

Hemodynamic profile

Cardiac exam

Murmur characteristics

Additional cardiac findings

Pulmonary exam

Respiratory findings

Endocarditis stigmata

Peripheral signs of infective endocarditis

PITFALLS

Diagnostic pitfalls in acute MR

Differential Diagnosis

Life-threatening mimics

Post-MI mechanical complications

Cardiogenic shock from other causes

Valvular mimics

Acute aortic regurgitation

Dynamic LVOT obstruction

Shock mimics

Cardiac tamponade

Septic shock with cardiac depression

Laboratory Tests

Cardiac biomarkers

Troponin

BNP and NT-proBNP

Metabolic and organ function

Lactate

Complete metabolic panel

Infection workup

Blood cultures

Complete blood count

Pre-operative and procedural labs

Coagulation studies

Arterial blood gas

Type and screen

Diagnostic Tests

Scoring Systems

IREMMI clinical classification of acute MR severity

Modified Duke Criteria for infective endocarditis

MRI

Cardiac MRI role in acute MR

CT

CT chest indications

CXR findings in acute MR

Ultrasound

Transthoracic echocardiography

Transesophageal echocardiography

Point-of-care ultrasound

Disposition

ICU and surgical indications

Cardiac ICU or monitored care mandatory

Immediate surgical referral

Transfer criteria

Transfer to cardiac surgery center

Discharge and follow-up

Discharge criteria for non-surgical management

Outpatient follow-up requirements

Treatment

Airway and oxygen support

Supplemental oxygen

Afterload reduction

Sodium nitroprusside

Nitroglycerin

Inotropic support

Dobutamine

Milrinone

Diuresis

Furosemide IV

Medications to avoid

Mechanical circulatory support

Intra-aortic balloon pump

Impella ventricular assist device

Endocarditis-specific treatment

Empiric antibiotic therapy

Special Populations

Pregnancy

Pregnancy-specific considerations

Geriatric

Older adult features

Pediatrics

Pediatric acute MR causes

Pediatric management differences

Background

Epidemiology

Incidence and etiology distribution

Mortality data

Pathophysiology

Acute hemodynamic mechanisms

Etiologic mechanisms

Therapeutic Considerations

Surgical timing principles

Medical bridge principles

Transcatheter options

Patient Discharge Instructions

copy discharge instructions

Acute mitral regurgitation follow-up care

Warning signs to return to the emergency room immediately

Endocarditis prevention (if applicable)

Lifestyle guidance

References

Guidelines and key sources

Major society guidelines

Landmark studies and evidence

Coding standards

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.