To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This chapter discusses the diagnosis, evaluation and management of valvular diseases including aortic stenosis (AS), aortic regurgitation (AR), mitral stenosis (MS) and mitral regurgitation (MR). Patients with AS are particularly sensitive to changes in cardiac output due to the pressure gradient across the aortic valve. Evaluation of any valvular pathology begins with the history and physical examination, and paying attention to whether valvular defect has been previously noted. If a new acute AR is discovered, the diagnosis of aortic dissection should be ruled out with a CTA or a transthoracic or transesophageal echocardiogram. Blood culture and antibiotics may be indicated if endocarditis or a perivalvular abscess is suspected. Characterization of valve dysfunction in the emergency department is not imperative if patients are hemodynamically stable. Echocardiography should be considered in patients who are hemodynamically unstable. Acute valvular dysfunction is usually secondary to a precipitating critical problem.