Aortic Insufficiency Flashcards
What is Aortic Regurgitation? AI or AR
Leaking of blood back into the LV.
What load does AI cause?
Increased LV preload
What type of murmur is associated with AR?
High pitched, blowing diastolic decrescendo murmur
Where is an AR murmur heard best?
Heard best at the LSB (left sternal border)
What is a Severe AI murmur known as?
Austin-Flint Murmur
Severe AI murmur
Low, diastolic “rumble” at the apex
Symptoms of AI include:
Dyspnea- SOB/SOA
Fatigue
Palpitations
Dizziness
Syncope
Over time-signs of CHF
Paroxysmal Nocturnal Dyspnea
DOE
Untreated may result in Rt HF (jugular vein distention, hepatomegaly, LE edema
Chronic AI causes
Aortic dialation
AS other valvular disease ( Bicuspid AOV, Prothestic AOV)
Rheumatic Heart Disease
Long Standing Hypertension
Atherosclerosis
Acute AI causes
Infective Endocarditis
Dissection of ascending aorta
Trauma causes a loss of commissural support
The more the aorta dialates the greater the risk for…….
Dissection
What is the physiologic response of the LV?
LVVO pattern
LVE
Hypercontractile Function
(think dialated and hypercontactile)
If AI progresses long-term what happens to LV fx?
LV systolic failure>>>>>>>heart failure
Refer to Starling Curve
When determining AI what three things should you observe?
Assess chamber sizes, LV volume, and systolic function
When should the complete Continuity Equation be used?
When proximal velocity > 1.0-1.5 m/s
What does significant Acute AI lead to?
LV volume and pressure overload
AI _______ the preload leading to LVVO. LVVO leads to _______.
INCREASES, LVE
When the AI jet strikes the AMVL what results?
Diastolic Flutter of the AMVL
M-Mode signs of increased LVEDP
- ) B-Bump
- ) Pre-mature closure of MV
- ) Pre-mature opening of AOV
What are MV Doppler signs of LVEDP?
Mdt< 140 ms
Increased E to A ratio
What are the typical reasons for AI?
Incomplete closure
AO root dialation
M-Mode Findings of AI
Diastolic Flutter of AMVL
LV volume overload
Severity Scale of AI
Mild- >500 msec
Moderate- 350-500 msec
Severe- <200 msec
AI Jet Width/ LVOT width ratio
<25% Mild AI
> 65% Severe AI
JSAA/LVOTA ratio
Mild - < 4%
Moderate- 4-24%
Mod-Severe- 24- 59%
Severe- > 60%
A Pressure 1/2 Time of < 200 ms may indicate
Significant AI
Generally the steeper the AI slope, the more ______ the AI
Severe
What are the views used for Spectral Doppler?
Apical 5 Chamber
Apical LAX
Color Flow for AI is seen in what views?
LAX
SAX
Apical 5 and 3C
What are the most common Doppler measurements acquired with AI?
P1/2t and Peak Velocity
What is the “normal” peak velocity of AI?
3-5 m/sec due to the pressure difference between the LV and AO during diastole.
PW or CFD Findings
♦SSN Diastolic flow reversal in Descending AO may be seen
♦Brief early reversed flow is normal
♦Holodiastolic reversed flow is consistant with moderate to severe AI
♦Subx: holodiastolic flow reversal in abdominal aorta=severe AI
