6.3 MTB Step 3 - Valvular Heart Disease (Aortic Regurgitation) Flashcards
AORTIC REGURGITATION (AR)
- What are (4) Common Causes of AR?
- What are (4) Rarer Causes of AR?
Common Causes of AR:
- Hypertension (HTN)
- Rheumatic Heart Disease
- Endocarditis
- Cystic Medial Necrosis
Rarer Causes of AR:
- Marfan Syndrome
- Ankylosing Spondylitis
- Syphilis
-
Reactive Arthritis - inflammatory arthritis of Large Joints, Inflammation of the Eyes (conjunctivitis & Uveitis), and Urethritis
- ”Can’t See, Can’t Pee, Can’t climb a Tree”
AORTIC REGURGITATION (AR)
What is the Most Common Presentation of AR?
Shortness of Breath (SOB)
+
Fatigue
AORTIC REGURGITATION (AR)
Describe the Murmur of AR and where it is Best Heard on Auscultation?
Diastolic Descrescendo murmur Heard Best at the Left Sternal Border
AORTIC REGURGITATION (AR)
What are (5) Unique Physical Findings that are rarely seen with AR?
- Quincke Pulse: Arterial or Capillary pulsations in the Fingernails
- Corrigan Pulse: High bounding pulses (a.k.a. “water-hammer pulse”)
- Musset Sign: Head Bobbing up & down w/ each pulse
- Duroziez Sign: Murmur Heard over the Femoral Artery
- Hill Sign: Blood Pressure gradient MUCH Higher in the Lower Extremities
AORTIC REGURGITATION (AR)
- What is the Best INITIAL Diagnostic Test for AR?
- What is a MORE Accurate Diagnostic Test for AR?
- What is the Most ACCURATE Diagnostic Test for AR?
- TTE
- TEE
- Left Heart Catheterization
**For CSS, also choose ECG & CXR (shows LVH)**
AORTIC REGURGITATION (AR)
What are (3) Best INITIAL Therapies for AR?
- ACEIs
- ARBs
- Nifedipine
**For CSS, add a Loop Diuretic (e.g., Furosemide)**
AORTIC REGURGITATION (AR)
For which (2) Conditions is Surgery the answer for AR Treatment, even if the patient is Asymptomatic?
EF < 55%
or
LVESD > 55mm
EF = Ejection Fraction
LVESD = Left Ventricular End Systolic Diamter
AORTIC REGURGITATION (AR)
Why does High pressure Dilate the Aortic Valve?
Law of LaPlace: The Wall Tension (force dilating a vessel) is proportionate to the Radius of the vessel times the Pressure on the inside of the vessel:
Tension = Radius x Pressure
- The Wider a vessel is, the Faster it will get pulled apart.
- Hence, the More the Aortic Ring or Aorta is Dilated, the Faster it will get pulled apart.
- Likewise, the Higher the Interior Pressure is, the Faster the Interior will be pulled apart.
- This force of being “Pulled Apart” (dilation) is called “Wall Tension” in the Law of LaPlace.
- ACEIs and ARBs Vasodilate Peripheral Arterioles (Lower Pressure = Lower Wall Tension)