Structural Heart Disease Emergencies

Jacob C. Jentzer, Bradley Ternus, Mackram Eleid, Charanjit Rihal

Research output: Contribution to journalArticlepeer-review


Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underlying SHD lesion. Patients with chronic SHD lesions which deteriorate due to intercurrent illness (eg, infection or arrhythmia) may not require urgent intervention, whereas patients with an acute SHD lesion often require definitive therapy. Medical stabilization prior to definitive intervention differs substantially between stenotic lesions (aortic stenosis, mitral stenosis, left ventricular outflow tract obstruction) and regurgitant lesions (aortic regurgitation, mitral regurgitation, ventricular septal defect). Patients with regurgitant lesions typically require aggressive afterload reduction and inotropic support, whereas patients with stenotic lesions may paradoxically require β-blockade and vasoconstrictors. Emergent cardiac surgery for patients with decompensated heart failure or cardiogenic shock carries a substantial mortality risk but may be necessary for patients who are not eligible for catheter-based percutaneous SHD intervention. This review explores initial medical stabilization and subsequent definitive therapy for patients with SHD emergencies.

Original languageEnglish (US)
Pages (from-to)975-988
Number of pages14
JournalJournal of Intensive Care Medicine
Issue number9
StatePublished - Sep 2021


  • aortic regurgitation
  • aortic stenosis
  • cardiogenic shock
  • heart failure
  • mitral regurgitation
  • mitral stenosis
  • valvular heart disease
  • ventricular septal defect

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


Dive into the research topics of 'Structural Heart Disease Emergencies'. Together they form a unique fingerprint.

Cite this