Aortic regurgitation Flashcards
What is aortic regurgitation?
reflux of blood from the aorta into LV during diastole.
AKA: aortic insufficiency
List 3 primary valvular defects that can cause chronic AR
Bicuspid aortic valve (most common in young in HICs)
Calcific aortic valve (most common in old in HICs)
Rheumatic heart disease (most common in LICs)
Give 3 epidemiological facts on AR
Increases with age
Most frequent in > 80s
M > F
What 4 conditions can cause aortic dilatation and thus lead to chronic aortic regurgitation
Connective tissue disorders: Marfan’s, Ehlers-Danlos
Chronic HTN
Aortitis
Thoracic aortic aneurysm
What is acute AR is most often caused by?
Infective endocarditis
Aortic dissection.
Chest trauma
Describe the pathophysiology of AR. What may explain the high volume collapsing pulse heard?
Reflux of blood into LV results in LV dilatation
Increases EDV + SV
Increased SV + low end-diastolic AORTIC pressure may explain the high-volume collapsing pulse
What are the presenting symptoms of a patient with chronic AR?
Initially ASYMPTOMATIC
Later on may develop symptoms of HF (e.g. exertional dyspnoea, orthopnoea, fatigue)
What are the presenting symptoms of a patient with severe acute AR?
Sudden cardiovascular collapse (LV can’t adapt to the rapid increase in EDV)
List 6 signs on examination of a patient with AR
Collapsing (water-hammer) pulse Wide pulse pressure Thrusting displaced apex beat Early diastolic murmur over aortic valve region Exaggerated arterial pulsations Low DBP
Where is the early diastolic murmur in AR best heard?
Left sternal edge when patient is sitting forward with breath held at top of expiration
List 4 eponymous signs seen in AR
Quincke’s: visible pulsation on nail bed
de Musset’s: head nodding in time with pulse
Corrigan’s: carotid pulsation
Traube’s: pistol shot (loud systolic + diastolic sounds) on auscultation of femoral arteries
What may be seen on CXR in AR?
Cardiomegaly
Dilatation of ascending aorta
Signs of pulmonary oedema (if accompanied by left heart failure)
What other murmur may be caused by AR? Describe this
Austin Flint murmur (heard at Apex)
Early diastolic rumbling murmur
Caused by blood flowing back through aortic valve + over the mitral valve causing mitral valve leaflets to vibrate
What may an ECG show in AR?
May show LV hypertrophy: Deep S in V1/2 Tall R in V5/6 Inverted T waves in lead I, aVL, V5/6 LAD
What may an echocardiogram in AR show?
Underlying cause (e.g. aortic root dilatation, bicuspid aortic valve)
Effects of AR (e.g. LV dilatation, fluttering of the anterior mitral valve leaflet)
Doppler echocardiogram can show AR + indicate severity
Repeat echos allow monitoring of progression (LV size + function)
