257 - Aortic Regurgitation

Question 1

Aortic insufficiency can be the result of ___, ___, or the combination of both.

Answer 1

Primary valve disease

Aortic root disease

Question 2

What are the main causes for aortic valve disease (7)?

Answer 2

Congenital (bicuspid)
Endocarditis
Rheumatic fever
Myxomatous (prolapse)
Traumatic
Syphilis
Ankylosing spondylitis

Question 3

What are the main causes for aortic root disease (5)?

Answer 3

Aortic dissection
Cystic medial degeneration
Marfan syndrome
BAV
HTN

Question 4

Patients with BAV can develop ___ and about ___ will require ____ between the ages of ___ to ___

Answer 4

AR
20%
Aortic surgery 
10
20

Question 5

Severe AR can occur even in ____ and ___, together with increased ____ and ___

Answer 5

Preserved EF
Normal LV EF
LVEDP
LVEDV

Question 6

Severe AR is a situation in which ____ of the LV increase the ____ in the LV require to create enough systolic stress

Answer 6

Dilatation

Systolic stress

Question 7

In chronic AR both ___ and ____ of the LV are increased

Answer 7

Preload

Afterload

Question 8

AR is ____ diastolic murmur

Answer 8

Decrescendo

Question 9

____ can occur in patients with AR because of increased _____ caused by ____.

Answer 9

Myocardial ischemia
Oxygen demand
LV hypertrophy

Question 10

____ of patients with pure AR are ___. Other patients groups usually include ____ and ____

Answer 10

75%
Men
Pregnant women with mitral rheumatic disease
Endocarditis

Question 11

Severe and chronic AR can be latent for ___ years

Answer 11

10-15

Question 12

Symptoms for latent AR may include: (5)

Answer 12

1. Uncomfortable sensation when laying down
2. Sinus tachycardia during exercise/ excitement
3. PVB causing inconvenience

Question 13

Advanced symptoms for AR include: (4)

Answer 13

1. Exertional dyspnea
2. Orthopnea
3. PND
4. Angina pectoris

Question 14

What is the atrial pulse heard in AR?

Answer 14

Rapidly rising water hammer which collapses suddenly as arterial pressure falls rapidly during late systole and diastole (Corrigan’s pulse).

Question 15

What is Quincke Sign which can be found in AR?

Answer 15

Capillary pulsation- flushing and paling of the skin at the root of the nail while pressure is applied to the tip of the nail.

Question 16

What is Traube’s sign?

Answer 16

A booming pistol shot sound which can be heard over the femoral arteries

Question 17

What is Duroziez’s sign?

Answer 17

To-and-fro murmur which is audible if the femoral artery is lightly compressed with a stethoscope

Question 18

In patients with severe AR ___ is usually inaudible

Answer 18

A2 ( the sound of the closure of the aortic valve)

Question 19

Complete more questions regarding auscultation and palpation in AR

Answer 19

for suree

Question 20

What is the typical ECG of a patient with AR?

Answer 20

LVH signs
ST depression 
T inversion in V5-6, I, aVL (LV strain)
Left axis
Wide QRS

Question 21

What is the typical echo of a patient with AR?

Answer 21

LVH
Normal-increased systolic function
Fast flutter of the front mitral valve