Aortic Regurgitation Flashcards

1
Q

causes of AR

A
  • structural valve problem
  • dilated aorta
  • combination
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2
Q

symptoms of chronic AR

A
  • may be asymptomatic
  • exertional dyspnea
  • reduced exercise tolerance
  • fatigue
  • uncomfortable forceful heartbeat
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3
Q

primary murmur for chronic AR

A
  • early diastolic
  • decrescendo
  • high pitched
  • blowing
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4
Q

associated murmurs of chronic AR

A
  • systolic ejection murmur

- Austin Flint murmur: diastolic rumble

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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
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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
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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
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8
Q

Quincke’s pulse

A
  • phasic blanching of the nail beds
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9
Q

Hill’s sign

A
  • LE systolic pressure exceeds UE systolic pressure by > 60 mmHg
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10
Q

de Musset’s sign

A
  • head bobbing with each systole
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11
Q

Corrigans (water hammer) pulse

A
  • palpable abrupt upstroke and rapid fall of arterial pulsation
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12
Q

Traube’s sign

A
  • pistol shot sound over femoral artery
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13
Q

Mueller’s sign

A
  • pulsating uvula
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14
Q

Bisferiens pulse

A
  • double systolic impulse in carotid or brachial artery
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15
Q

EKG findings of chronic AR

A
  • LVH
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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