Aortic regurgitation

Question 1

What is the definition of Aortic regurgitation?

Answer 1

• Leaking of the aortic valve causing blood flow into the opposite direction (back to the heart)
• during ventricular diastole

Question 2

What is the pathophysiology of Aortic regurgitation?

Answer 2

1. Dysfunctional aortic valve is causes by disease of the aortic valve
2. Dilatation of the aortic root and ascending aorta as root dilates and pulls apart leaflets

Question 3

What are the causes of AR due to valve disease?

Answer 3

1. Rheumatic fever - most common cause
2. Connective tissue disease -
   Rheumatoid arthritis / Lupus

Acute presentation : Infective endocarditis

Question 4

What are the causes of AR due to aortic root disease?

Answer 4

• Hypertension
• Syphilis
• Marfans, Ehler-Danlos syndrome
• Spondylarthropathies - Ankylosing spondylitis

Acute presentation ; Aortic dissection

Question 5

What are the complications of Aortic regurgitation?

Answer 5

1. Heart failure
   * High blood volume due to back flow of blood as a result of aortic regurgitation
   * LV hypertrophy and dysfunction
   Pulmonary oedema and heart failure

Question 6

What is heard on auscultation of AR?

Answer 6

• Murmurs : Early diastolic murmur
• Heard in the left apex

Question 7

What are the clinical signs of Aortic regurgitations?

Answer 7

1. Wide pulse pressure ( increases systolic and decreased diastolic blood pressure)
2. collapsing pulse
3. Quinke’s sign - nailbed pulsation
4. De Musset’s sign - head bobs in time with heartbeat

Question 8

What are the indicated investigations?

Answer 8

1. ECHO
2. CXR - cardiomegaly

Question 9

What is the management of Aortic regurgitation?

Answer 9

1. Medical management of heart failure : vasodilators to reduce after load
2. Surgical management for
   * Symptomatic patients with severe AR
   * Asymptomatic patients with severe AR with LV systolic dysfunction