aortic regurgitation

Question 1

what is aortic regurgitation

Answer 1

Leakage of blood into LV during diastole due to ineffective coaptation of aortic cusps

Question 2

causes of aortic regurgitation

Answer 2

Congenital bicuspid aortic valve - chronic

Rheumatic heart disease (rheumatic fever) - chronic

Infective endocarditis - acute

Question 3

pathology for aortic regurgitation

Answer 3

Combined pressure and volume overload 🡪 LV dilatation and LVH

Question 4

symptoms of aortic regurgitation

Answer 4

Exertional dyspnoea
Orthopnoea
Paroxysmal nocturnal dyspnoea
Palpitations
Angina
Syncope

Question 5

signs of aortic regurgitation

Answer 5

Collapsing (water hammer) pulse
Wide pressure pulse
Quincke’s sign – capillary pulsation in nail beds
De Musset’s sign – head nodding with each heart beat
Muller’s sign – visible pulsations of uvula
Heart sounds

Question 6

what heart sounds in aortic regurgitation

Answer 6

Displaced hyperdynamic apex beat
Early diastolic murmur heard at left sternal edge in 4th intercostal space. Accentuated when the patient sits forward with their breath held in expiration.
Systolic ejection murmur

Question 7

investigations for aortic regurgitation

Answer 7

Echocardiogram
ECG – shows evidence of LVH
CXR - shows a large heart (cardiomegaly) and occasional dilatation of the ascending aorta

Question 8

treatment for aortic regurgitation

Answer 8

IE prophylaxis

Vasodilators – ACE inhibitors e.g. Ramiprils only if symptomatic or hypertension

Surgical – replace valve before LV dysfunction