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ANKI Cardiovascular > [5] Aortic Regurgitation > Flashcards

[5] Aortic Regurgitation Flashcards

1
Q

What happens in aortic regurgitation?

A

The pressure in the left ventricle falls below the pressure in the aorta, which causes an inability of the aortic valve to completely close, and thus there is leakage of the blood from the aorta into the left ventricle.

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2
Q

What is the result of aortic regurgitation on the aortic blood pressure?

A

It decreases the diastolic blood pressure in the aorta, and so increases the difference between systolic and diastolic pressure - the pulse pressure

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3
Q

What effect does aortic regurgitation have on the structure of the heart?

A

Causes left ventricular hypertrophy

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4
Q

What causes left ventricular hypertrophy in aortic regurgitation?

A

The volume overload due to elevated pulse pressure, and other factors

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5
Q

What % of cases of aortic regurgitation are idiopathic?

A

80%

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6
Q

What are some potential causes of aortic regurgitation?

A
  • Congential heart disease
  • Age related changes to the heart
  • Endocarditis
  • Rheumatic fever
  • Marfan syndrome
  • Lupus
  • Trauma
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7
Q

What congential heart disease can cause aortic regurgitation?

A

Bicuspid, or less commonly unicuspid or quadcuspid valve

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8
Q

What are the symptoms of aortic regurgitation?

A
  • Dyspnoea on exertion
  • Orthopnoea
  • Paroxysmal noctural dyspnoea
  • Palpitations
  • Angina
  • Cyanosis
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9
Q

What is involved in the diagnosis of aortic regurgitation?

A
  • Examination
  • Echocardiogram
  • CXR
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10
Q

What are the examination signs of aortic regurgitation?

A
  • Corrigan’s sign
  • De Musset’s sign
  • Quincke’s sign
  • High volume, collapsing pulse
  • Volume loaded, displaced JVP
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11
Q

What is Corrigan’s sign?

A

An abrupt distention and collapse of the carotid arteries, sometimes causing ear movement and/or head nodding

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12
Q

What is De Musset’s sign?

A

Head bobbing that is seen in aortic regurgitation

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13
Q

What is Quinke’s sign?

A

The visible pulsation of the red colouration of the finger nailbed seen in severe aortic regurgitation.

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14
Q

What might make Quincke’s sign easier to detect?

A

Blanching part of the nailbed by slight pressure on the nail

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15
Q

What is the use of echocardiograms in aortic regurgitation?

A

They can help determine the cause and severity of the condition

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16
Q

What might an echocardiogram show in aortic regurgitation?

A
  • Vegetations on AV
  • Fluttering of AV cusps during diastole
  • Dilation of LV cavity due to volume overload
  • Abnormal valves
17
Q

What does fluttering of AV cusps during diastole on echocardiogram show?

A

Rupture due to endocarditis/degeneration

18
Q

What might the CXR show in aortic regurgitation?

A
  • Left ventricular hypertrophy
  • Dilated aorta
19
Q

What management is indicated in symptomatic acute severe AR?

A

Urgent surgical intervention

20
Q

What are the goals of treatment in chronic severe aortic regurgitation?

A
  • Prevent death
  • Diminish symptoms
  • Prevent the development of heart failure
  • Avoid arthritic complications
21
Q

What lifestyle changes can be made in the management of aortic regurgitation?

A
  • Healthy diet
  • Maintaining healthy weight
  • Regular physical activity
  • Managing stress
  • Quit smoking
  • Controlling high blood pressure
22
Q

Where is medical therapy useful in aortic regurgitation?

A
  • For short-term therapy in patients with severe heart failure, before proceeding to aortic valve surgery
  • In individuals with chronic severe AR and heart failure and co-morbid hypertension, when surgery is contra-indicated
23
Q

What drugs are used in patients with aortic regurgitation and severe heart failure before proceeding to aortic valve surgery?

A

Vasodilators and inotropic agents

24
Q

What drugs are used in patients with chronic severe AR and heart failure, and co-morbid hypertension, when surgery is contraindicated?

A

ACE inhibtiors or angiotensin-II receptor antagonists

25
Q

When is surgery indicated in aortic regurgitaiton?

A

When patients are symptomatic, or asymptomatic when left ventricular function starts to deteriorate

26
Q

How is isolated aortic regurgitation treated?

A

Aortic valve repalcement

27
Q

What techniques can be used to replace the aortic valve?

A

Several techniques, including separating valve flaps that have fused, reshaping or removing excess valve tissue, or patching holes in a valve

28
Q

What are the potential complications of aortic regurgitation?

A
  • Heart failure
  • Endocarditis
  • Arrythmias
  • Death

ANKI Cardiovascular (24 decks)

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