Aortic Insufficiency

Question 1

What 3 congenital conditions can lead to a valvular etiology of Aortic Insufficiency (AI)?

Answer 1

1. Bicuscpid Aortic Valve
2. Ventricular Septal Defect
3. CT disorders (Marfan, Ehlers)

Question 2

What 3 acquired conditions can lead to a valvular etiology of AI?

Answer 2

1. Infection: endocarditis
2. Rheumatic: also check for mitral valve disease
3. Degenerative

Question 3

What is an Austin Flint murmur?

Answer 3

Diastolic murmur thought to be from mitral stenosis caused by a forceful jet of regurgitated blood from the insufficient aortic valve.

Question 4

What is the Durozeiz Sign?

Answer 4

Systolic murmur over femoral artery when stethoscope is compressed proximally, and a diastolic murmur over femoral artery when stethoscope is compressed distally. Indicates severe AI.

Question 5

What is pulse pressure?

Answer 5

Basically the difference of the systolic and diastolic pressures. A wide pulse pressure, meaning a large difference between the two is sometimes seen in AI.

Question 6

What is the Quincke Pulse?

Answer 6

Capillary pulsations visible at the lip or proximal nail bed.

Question 7

What is the Hill Sign?

Answer 7

Lower extremity systolic pressure more than 60mmHg greater than brachial systolic pressure.

Question 8

What is the de Musset Sign?

Answer 8

Head bobbing with each systole.

Question 9

What is the Corrigan (water-hammer) pulse?

Answer 9

Palpable abrupt upstroke and rapid fall of arterial pulsation.

Question 10

What is the Trauble Sign?

Answer 10

Pistol shot sound heard over the femoral artery.

Question 11

What is the Mueller Sign?

Answer 11

Pulsating uvula

Question 12

What is the Bisferiens Pulse?

Answer 12

Double Systolic impulse in the carotid and brachial arteries.

Question 13

Which diagnostic modality is best for long-term follow up and timing for surgical procedures?

Answer 13

Echocardiography

Question 14

What are two measurements that can cause a worse prognosis for a previously asymptomatic AI?

Answer 14

1. Ejection fraction less than 55%

2. LV end systolic dimension greater than 55mm

Question 15

What is medical treatment for AI?

Answer 15

Nifedipine: may delay need for AVR surgery tho not very effective.

Other vasodilators are controversial.

Question 16

What are 3 indications for surgery to replace a valve in AI?

Answer 16

1. LVEF less than 55%
2. LV end systolic dimension greater than 55mm
   or diastolic greater than 75mm
3. Development of symptoms

Question 17

How is acute AI diagnosed differently from chronic?

Answer 17

Acute has weakness and severe dyspnea with lack of peripheral signs. There is also tachycardia, hypotension and pulmonary edema.
EKG shows sinus tach without LVH.
CXR shows pulmonary edema without LVH.

Question 18

What is the test of choice for AI?

Answer 18

Echo

Question 19

What is the treatment for acute AI?

Answer 19

Surgery to replace the valve. If due to infection, do antibiotic prophylaxis for 7 days before valve replacement in stable patients.

Question 20

What two Txs are contraindicated in acute AI?

Answer 20

Beta blockers and Intra-aortic balloon pump.