Valvulopathy Part II: Stenosis

In this episode of ICUedu, Sara Crager delves into the medical management of stenotic valves, specifically aortic and mitral stenosis, in acutely ill patients. She highlights the importance of understanding the underlying physiology to guide counterintuitive management strategies. The discussion covers two core principles: fixed resistance and secondary consequences to cardiac anatomy and physiology, detailing how these principles manifest in aortic and mitral stenosis. For aortic stenosis, management focuses on maintaining heart rate and rhythm, using phenylephrine to support blood pressure, and carefully managing volume status to avoid rapid shifts. For mitral stenosis, the approach involves controlling heart rate and rhythm, using vasopressin to maintain systemic vascular resistance, and aggressive diuresis to offload the left atrium and manage right ventricular failure.