Aortic Insufficiency Flashcards
What 3 congenital conditions can lead to a valvular etiology of Aortic Insufficiency (AI)?
- Bicuscpid Aortic Valve
- Ventricular Septal Defect
- CT disorders (Marfan, Ehlers)
What 3 acquired conditions can lead to a valvular etiology of AI?
- Infection: endocarditis
- Rheumatic: also check for mitral valve disease
- Degenerative
What is an Austin Flint murmur?
Diastolic murmur thought to be from mitral stenosis caused by a forceful jet of regurgitated blood from the insufficient aortic valve.
What is the Durozeiz Sign?
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.
What is pulse pressure?
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.
What is the Quincke Pulse?
Capillary pulsations visible at the lip or proximal nail bed.
What is the Hill Sign?
Lower extremity systolic pressure more than 60mmHg greater than brachial systolic pressure.
What is the de Musset Sign?
Head bobbing with each systole.
What is the Corrigan (water-hammer) pulse?
Palpable abrupt upstroke and rapid fall of arterial pulsation.
What is the Trauble Sign?
Pistol shot sound heard over the femoral artery.
What is the Mueller Sign?
Pulsating uvula
What is the Bisferiens Pulse?
Double Systolic impulse in the carotid and brachial arteries.
Which diagnostic modality is best for long-term follow up and timing for surgical procedures?
Echocardiography
What are two measurements that can cause a worse prognosis for a previously asymptomatic AI?
- Ejection fraction less than 55%
2. LV end systolic dimension greater than 55mm
What is medical treatment for AI?
Nifedipine: may delay need for AVR surgery tho not very effective.
Other vasodilators are controversial.
What are 3 indications for surgery to replace a valve in AI?
- LVEF less than 55%
- LV end systolic dimension greater than 55mm
or diastolic greater than 75mm - Development of symptoms
How is acute AI diagnosed differently from chronic?
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.
What is the test of choice for AI?
Echo
What is the treatment for acute AI?
Surgery to replace the valve. If due to infection, do antibiotic prophylaxis for 7 days before valve replacement in stable patients.
What two Txs are contraindicated in acute AI?
Beta blockers and Intra-aortic balloon pump.
