[5] Aortic Regurgitation Flashcards
What happens in aortic regurgitation?
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.
What is the result of aortic regurgitation on the aortic blood pressure?
It decreases the diastolic blood pressure in the aorta, and so increases the difference between systolic and diastolic pressure - the pulse pressure
What effect does aortic regurgitation have on the structure of the heart?
Causes left ventricular hypertrophy
What causes left ventricular hypertrophy in aortic regurgitation?
The volume overload due to elevated pulse pressure, and other factors
What % of cases of aortic regurgitation are idiopathic?
80%
What are some potential causes of aortic regurgitation?
- Congential heart disease
- Age related changes to the heart
- Endocarditis
- Rheumatic fever
- Marfan syndrome
- Lupus
- Trauma
What congential heart disease can cause aortic regurgitation?
Bicuspid, or less commonly unicuspid or quadcuspid valve
What are the symptoms of aortic regurgitation?
- Dyspnoea on exertion
- Orthopnoea
- Paroxysmal noctural dyspnoea
- Palpitations
- Angina
- Cyanosis
What is involved in the diagnosis of aortic regurgitation?
- Examination
- Echocardiogram
- CXR
What are the examination signs of aortic regurgitation?
- Corrigan’s sign
- De Musset’s sign
- Quincke’s sign
- High volume, collapsing pulse
- Volume loaded, displaced JVP
What is Corrigan’s sign?
An abrupt distention and collapse of the carotid arteries, sometimes causing ear movement and/or head nodding
What is De Musset’s sign?
Head bobbing that is seen in aortic regurgitation
What is Quinke’s sign?
The visible pulsation of the red colouration of the finger nailbed seen in severe aortic regurgitation.
What might make Quincke’s sign easier to detect?
Blanching part of the nailbed by slight pressure on the nail
What is the use of echocardiograms in aortic regurgitation?
They can help determine the cause and severity of the condition
What might an echocardiogram show in aortic regurgitation?
- Vegetations on AV
- Fluttering of AV cusps during diastole
- Dilation of LV cavity due to volume overload
- Abnormal valves
What does fluttering of AV cusps during diastole on echocardiogram show?
Rupture due to endocarditis/degeneration
What might the CXR show in aortic regurgitation?
- Left ventricular hypertrophy
- Dilated aorta
What management is indicated in symptomatic acute severe AR?
Urgent surgical intervention
What are the goals of treatment in chronic severe aortic regurgitation?
- Prevent death
- Diminish symptoms
- Prevent the development of heart failure
- Avoid arthritic complications
What lifestyle changes can be made in the management of aortic regurgitation?
- Healthy diet
- Maintaining healthy weight
- Regular physical activity
- Managing stress
- Quit smoking
- Controlling high blood pressure
Where is medical therapy useful in aortic regurgitation?
- 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
What drugs are used in patients with aortic regurgitation and severe heart failure before proceeding to aortic valve surgery?
Vasodilators and inotropic agents
What drugs are used in patients with chronic severe AR and heart failure, and co-morbid hypertension, when surgery is contraindicated?
ACE inhibtiors or angiotensin-II receptor antagonists
