Aortic Insufficiency

Question 1

What is Aortic Regurgitation? AI or AR

Answer 1

Leaking of blood back into the LV.

Question 2

What load does AI cause?

Answer 2

Increased LV preload

Question 3

What type of murmur is associated with AR?

Answer 3

High pitched, blowing diastolic decrescendo murmur

Question 4

Where is an AR murmur heard best?

Answer 4

Heard best at the LSB (left sternal border)

Question 5

What is a Severe AI murmur known as?

Answer 5

Austin-Flint Murmur

Question 6

Severe AI murmur

Answer 6

Low, diastolic “rumble” at the apex

Question 7

Symptoms of AI include:

Answer 7

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

Question 8

Chronic AI causes

Answer 8

Aortic dialation

AS other valvular disease ( Bicuspid AOV, Prothestic AOV)

Rheumatic Heart Disease

Long Standing Hypertension

Atherosclerosis

Question 9

Acute AI causes

Answer 9

Infective Endocarditis

Dissection of ascending aorta

Trauma causes a loss of commissural support

Question 10

The more the aorta dialates the greater the risk for…….

Answer 10

Dissection

Question 11

What is the physiologic response of the LV?

Answer 11

LVVO pattern

LVE

Hypercontractile Function

(think dialated and hypercontactile)

Question 12

If AI progresses long-term what happens to LV fx?

Answer 12

LV systolic failure>>>>>>>heart failure

Refer to Starling Curve

Question 13

When determining AI what three things should you observe?

Answer 13

Assess chamber sizes, LV volume, and systolic function

Question 14

When should the complete Continuity Equation be used?

Answer 14

When proximal velocity > 1.0-1.5 m/s

Question 15

What does significant Acute AI lead to?

Answer 15

LV volume and pressure overload

Question 16

AI _______ the preload leading to LVVO. LVVO leads to _______.

Answer 16

INCREASES, LVE

Question 17

When the AI jet strikes the AMVL what results?

Answer 17

Diastolic Flutter of the AMVL

Question 18

M-Mode signs of increased LVEDP

Answer 18

1. ) B-Bump
2. ) Pre-mature closure of MV
3. ) Pre-mature opening of AOV

Question 19

What are MV Doppler signs of LVEDP?

Answer 19

Mdt< 140 ms

Increased E to A ratio

Question 20

What are the typical reasons for AI?

Answer 20

Incomplete closure

AO root dialation

Question 21

M-Mode Findings of AI

Answer 21

Diastolic Flutter of AMVL

LV volume overload

Question 22

Severity Scale of AI

Answer 22

Mild- >500 msec

Moderate- 350-500 msec

Severe- <200 msec

Question 23

AI Jet Width/ LVOT width ratio

Answer 23

<25% Mild AI

> 65% Severe AI

Question 24

JSAA/LVOTA ratio

Answer 24

Mild - < 4%

Moderate- 4-24%

Mod-Severe- 24- 59%

Severe- > 60%

Question 25

A Pressure 1/2 Time of < 200 ms may indicate

Answer 25

Significant AI

Question 26

Generally the steeper the AI slope, the more ______ the AI

Answer 26

Severe

Question 27

What are the views used for Spectral Doppler?

Answer 27

Apical 5 Chamber

Apical LAX

Question 28

Color Flow for AI is seen in what views?

Answer 28

LAX

SAX

Apical 5 and 3C

Question 29

What are the most common Doppler measurements acquired with AI?

Answer 29

P1/2t and Peak Velocity

Question 30

What is the “normal” peak velocity of AI?

Answer 30

3-5 m/sec due to the pressure difference between the LV and AO during diastole.

Question 31

PW or CFD Findings

Answer 31

♦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