aoritc regurgitation

Question 1

what is Aortic regurgitation

Answer 1

when atrial valve does not close completely and blood leaks back into the heart

Question 2

aortic cusp abnormalities

Answer 2

infection: bacterial endocarditis, rheumatic fever
congenital: bicuspid AoV commonly associated with Marfan’s syndrome

Question 3

aortic root abnormalities

Answer 3

root dilations

• marfans syndrome, ehler’s-danlos syndrome
• syphillis
• ankylosis spondylitis -bamboo spine
• aortic dissection

Question 4

increased afterload

Answer 4

systemic hypertension
supravalvular aortic stenosis
coartation of the aorta

Question 5

results of aortic regurgitation

Answer 5

-flow back into the left ventricle
-decreased blood pressure
-progressive left ventricle enlargement (big and baggy)
-increased left ventricle dilation and large stroke volume
-results in left ventricle failure reduced LV ejection fraction because it cannot pump well
pulmonary edema

Question 6

symptoms of aortic regurgitation

Answer 6

chronic: 
asymptomatic for many years
exertional dyspnea 
paroxymal nocturnal dyspnea 
atypical chest pain/angina 

acute
severe dyspnea at rest

Question 7

why chest pain with chronic aortic regurgitation

Answer 7

coronary arteries fill during diastole so if DPB is low will have a decreased coronary artery perfusion

Question 8

aortic regurgitation physical exam findings

Answer 8

• soft high pitched diastolic murmur -heard on s2
• widened pulse pressure (increased SBP- decreased DBP)
• de mussets sign (head bob with each pulse)
• apical pulse prominent and displaced laterally
• austin flint murmur

Question 9

austin flint murmur

Answer 9

functional mitral stenosis- this is when the atrial valve is pushing against the mitral valve and pushing it closed
-it is a low pitch rumbling

Question 10

gold standard for diagnosis

Answer 10

echo

Question 11

chronic medical plan

Answer 11

medical therapy
loop diuretics
afterload reducers (nitrates, hydralyzine)
NO beta BLOCKERS

Question 12

aortic regurgitation surgical intervention

Answer 12

with EF is low that you become symptomatic usually 40% or lower
when aortic root diameter is less than 5 cm

Question 13

what to keep in mind with aortic valve replacement

Answer 13

if patient is a fall risk you dont want them anticoagulated so stay away from mechanical valves