Aortic Incompetence Flashcards
Clinical Features of aortic incompetence (pulse, BP, apex, thrill, auscultation)
Collapsing pulse/Corrigan’s sign
Wide pulse pressure
Displaced hyperkinetic apex beat
Thrill in aortic area
Early diastolic murmur loudest over left sternal edge sat forward on expiration
What clinical features suggest severe aortic incompetence?
Collapsing pulse
Pulmonary oedema
S3
What are the causes of aortic incompetence?
Congenital:Bicuspid valve, Perimembranous VSD
Acute: Endocarditis, dissection
Chronic: aortic root dilatation due to chronic HTN, calcific degenerative valve disease, rheumatic fever, drugs (pergolide), hereditary CTD, axial spondyloarthropathy, HTN, syphilis, vasculitis
What else causes a collapsing pulse?
Pregnancy
PDA
Pagets
Anaemia
Thyrotoxicosis
How would you investigate this patient?
Bedside: ECG
Bloods
Imaging: TTE/TOO,
CXR
Special: cardiac catheterisation
How would you manage this patients?
Monitor
Medical: ACEi, ARBs to reduce after load
Surgical: AVR
When would you consider acute AVR?
In the context of dissection or aortic root abscess/endocarditis
When would you replace the AV in a chronic setting?
Symptomatic
OR
Severe AR and any of the following features: LV dilatation, EF <50%, significant root dilatation >55mm, undergoing any other cardiac surgery
What is the prognosis if symptomatic and EF <50%?
1% at 5 years
Prognosis if symptomatic and all three criteria for surgical replacement met?
65% at 3 years
Differentials of aortic regorge murmur
Pulmonary regurgitation
What are the difference between AR and PR?
PR is loudest at left upper sternal border and no peripheral bounding pulse
Hereditary connective tissue disease causing AR
Marfans
Loeys Dietz
MASS
Ehlers Danlos
