Aortic Regurgitation

Question 1

what symptoms does acute aortic regurgitation present with?

Answer 1

• sudden cardiovascular collapse
• pulmonary oedema
• pallor
• sweating
• peripheral vasoconstriction

Question 2

what symptoms does chronic aortic regurgitation present with?

Answer 2

• exertional dyspnoea
• orthopnoea
• paroxysmal nocturnal dyspnoea
• stable angina - due to reduction in diastolic coronary perfusion

Question 3

what are the key presenting features of aortic regurgitation?

Answer 3

• collapsing pulse
• wide pulse pressure
• early diastolic murmur - heard best over the left sternal border

Question 4

what is the typical ascultation findings in aortic regurgitation?

Answer 4

early diastolic murmur
* heard best in the aortic area whilst the patient is learnt forward and on exhalation
* soft S1 and occasionally an ejection flow murmur

Question 5

what are the peripheral examination findings in aortic regurgitation?

Answer 5

• ‘waterhammer’ pulse = corrigan’s pulse
• de musset’s sign
• quincke’s sign
• traube’s sign
• muller’s sign
• widened pulse pressure (low diastolic pressure) is usually present

Question 6

what is de musset’s sign?

Answer 6

bobbing of the head in synchrony with the beating of the heart

Question 7

what is quincke’s sign?

Answer 7

pulsation of the nail beds

Question 8

what is traube’s sign?

Answer 8

‘pistol shot’ like bruit heard on ausculation of the femoral pulse

Question 9

what is muller’s sign?

Answer 9

pulsation or bobbing of the uvula

Question 10

what are the acute causes of aortic regurgitation?

Answer 10

• infective endocarditis
• aortic dissection
• traumatic rupture of the valve leaflets - e.g. blunt trauma or deceleration injury
• iatrogenic causes - e.g. balloon valvotomy or trans catheter aortic valve implantation (TAVI)

Question 11

what are the chronic causes of aortic regurgitation?

Answer 11

• valvular causes - e.g. calcific aortic valve disease, congenital disease, rheumatic heart disease, marfan’s syndrome
• aortic root diltation - e.g. congential bicuspid aortic valve, ehlers-danlos, giant cell arteritis, takayasu’s arteritis

Question 12

what is the gold standard test for valvular disease?

Answer 12

echocardiogram

Question 13

what investigations can be done in aortic regurgitation?

Answer 13

• echocardiogram
• cardiac MRI - if echo inconclusive
• invasive cardiac catheterisation and angiography - if cardiac MRI inconclusive