Aortic Regurg Flashcards
History
Asymptomatic Dyspnoea Fatigue Symptoms of LV failure Less common angina pectorals
Exam- pulse
Collapsing pulse
Corrigans sign- dancing carotids
Quinckes sign
Pistol shot over femorals
Exam-heart
Apex beat displaced HS3 Early diastolic murmur high pitched Ejection click- bicuspid aortic valve Austin flint mid diastolic murmur at apex
Exam- general
De mussets sign- head Bobbing
Dancing carotids
Wide pulse pressure
Muller’s sign- uvula
Pupils for argyll Robertson pupil of syphilis
Look for marfans - high arched palate, arm span greater than height
Check joints for ank spond and RA
Causes of chronic regurg
RF hypertension Atherosclerosis Endocarditis Syphilis Marfans RA Bicuspid aortic valve
Investigations
CXR- usually normal maybe some valve calcification/ cardiomegaly
ECG- left ventricular hypertrophy, strain, atrial hypertrophy
Echo- Doppler
Exercise testing
Cardiac catheterisation- if cad is suspected
Prevalence in the elderly
13% aged 75-86 have moderate to severe regurg
Natural history
Sudden death <0.2% year
Asymptomatic patients with lv dysfunction >25% chance per year for progression to symptomatic
Clinical signs of severity
Wide pulse pressure
Soft hs2
Hs3
Signs of lv failure
Hills sign
Higher systolic pressure in the leg than in the arm
Difference in leg is bigger the more severe
Austin flint murmur
Apical low pitched diastolic murmur caused by the vibration of the anterior mitral cusp of the regurg jet- heard at apex
Acute aortic regurg causes
Infective endo Aortic dissection Trauma Failure of prosthetic valve Rupture of sinus of valsalva
Natural hx of asymptomatic aortic regurg
4% of patients develop symptoms, lv dysfunction or both per year
Treatment
Surgically- timing important depends on severity of symptoms and extent of Lv dysfunction
Valve replacement should happen ASAP as lv dysfunction is detected
Indications: symptoms of lv failure and ejection fraction under 50 but over 30
Reduction in exercise ejection fraction
Choice of valve
Young- prosthetic more durable- need anti coag
Elderly- tissue but prone to calcification and degeneration good when anti coags are contraindicated
