Aortic Regurgitation Flashcards
1
Q
causes of AR
A
- structural valve problem
- dilated aorta
- combination
2
Q
symptoms of chronic AR
A
- may be asymptomatic
- exertional dyspnea
- reduced exercise tolerance
- fatigue
- uncomfortable forceful heartbeat
3
Q
primary murmur for chronic AR
A
- early diastolic
- decrescendo
- high pitched
- blowing
4
Q
associated murmurs of chronic AR
A
- systolic ejection murmur
- Austin Flint murmur: diastolic rumble
5
Q
2 proposed mechanisms of Austin Flint murmur
A
- “functional” mitral stenosis resulting from aortic regurgitant jet forcing the anterior mitral leaflet into a partially closed position
- diastolic rumble results from fluttering of the anterior mitral leaflet caused by the aortic regurgitant jet
6
Q
associated findings of AR
A
- Duroziez sign
- wide pulse pressure
- Quincke’s pulse
- Hill’s sign
- de Musset’s sign
- Corrigan’s (water hammer) pusle
- Traube’s sign
- Mueller’s sign
- Bisferiens pulse
7
Q
Duroziez sign
A
- systolic murmur over femoral artery when stethoscope is compressed proximally
- diastolic murmur over femoral artery when stethoscope is compressed distally
- most predictive sign of severe AR
8
Q
Quincke’s pulse
A
- phasic blanching of the nail beds
9
Q
Hill’s sign
A
- LE systolic pressure exceeds UE systolic pressure by > 60 mmHg
10
Q
de Musset’s sign
A
- head bobbing with each systole
11
Q
Corrigans (water hammer) pulse
A
- palpable abrupt upstroke and rapid fall of arterial pulsation
12
Q
Traube’s sign
A
- pistol shot sound over femoral artery
13
Q
Mueller’s sign
A
- pulsating uvula
14
Q
Bisferiens pulse
A
- double systolic impulse in carotid or brachial artery
15
Q
EKG findings of chronic AR
A
- LVH
16
Q
CXR findings of chronic AR
A
- LV enlargement
- eccentric more common
- ascending aorta may be dilated
17
Q
natural history of chronic AR
A
- prognosis worsens significantly when LV systolic dysfunction develops (LVEF < 55%) or when significant LV dilatation develops (LV ES dimension > 55 mm)
18
Q
rule of 55
A
- LVEF < 55% or LV end systolic dimension > 55 mm
19
Q
treatment of chronic AR
A
- nifedipine
- ACE-I, ARBs, hydralazine if HTN present
20
Q
surgical indications in chronic AR
A
- decline in LV systolic function (LVEF < 55%)
- increase in LV size (LV end systolic > 55 mm or LV end diastolic > 75 mm)
- development of symptoms - fatigue is most common, worsening of exercise tolerance
- heart failure symptoms
21
Q
symptoms of acute AR
A
- severe dyspnea
- weakness
22
Q
physical findings of acute AR
A
- hypotension
- tachycardia
- pulmonary edema
- no peripheral arterial signs
- pulse pressure not widened
- diastolic murmur soft and short
23
Q
EKG findings of acute AR
A
- sinus tachycardia
- LVH may be absent
24
Q
CXR findings of acute AR
A
- pulmonary edema (usually)
- LV size is usually normal
- ascending aorta may be dilated
25
Q
test of choice to diagnose acute AR
A
- echo
26
Q
treatment of acute AR
A
- surgery for hemodynamically unstable patients
- medical therapy while awaiting surgery includes dobutamine and IV vasodilators
- beta blockers and IABP are contraindicated
