Aortic Regurgitation

Question 1

Hemodynamic findings of acute AR
LV vol, LVEDP
LA volume, LA pressure
TSV, FSV
EF
Gradient?
Pulse pressure?

Answer 1

Hemodynamic findings of acute AR
-Normal LV volume, nondilated, noncompliant
-Increase in LVEDP (steep increase in LV pressure throughout diastole; severe increase in LVEDP)
-Normal LA volume
-Increase in mean LA pressure
-Decrease SV, increase EDV
-Mildly widened PP
-Reverse LV-LA gradient in mid to late diastole
-There may be equalization of aortic and LV end-diastolic pressure (at ~35-40 mmHg for example) with diastasis in mid or end diastole

Question 2

Hemodynamic findings of Chronic Compensated Severe AR
LV vol, LVEDP
LA volume, LA pressure
TSV, FSV
EF
Gradient?
Pulse pressure?

Answer 2

Hemodynamic findings of acute AR
-Dilated LV size, increase in LV volume, compliant LV
-Normal LVEDP (diastolic rise in LV pressure is much more gradual)
-Dilated LA, normal mean LA pressure
-Increase in TSV, FSV, CO is maintained
-Increase in EF
-Widened pulse pressure

Question 3

Causes of widened PP in chronic AR

Answer 3

Result of backward flow in the LV but because of the increase in stroke volume, the pulse pressure is much wider in acute AI than in chronic AI

Question 4

Pulsus bisferiens in chronic AR is caused by

Answer 4

The peripheral femoral pressure may get excessively amplified and may exceed the central systolic pressure by up to 50 mmHg. This is an exaggeration of a normal effect and is secondary to the hyperdynamic state and the excess of reflected waves in the periphery.

Question 5

The aortic dicrotic notch is _____________ in severe AI and is a sensitive marker for severe AI

Answer 5

Effaced

Question 6

Hemodynamic findings of Chronic Decompensated Severe AR
LV vol, LVEDP
LA volume, LA pressure
TSV, FSV
EF
Gradient?
Pulse pressure?

Answer 6

Hemodynamic findings of Chronic Decompensated Severe AR
-Dilated LV, compliant LV
-Increase in LVEDP (in Mild- gradual LV diastolic pressure slope and an increase in LVEDP that remains much lower than the aortic pressure; Severe - steeply rising LV diastolic pressure, a minimal difference (<10 mmHg) or equilibration between LVEDP and aortic end-diastolic pressure)
-Dilated LA, increase LA pressure, increase in mean PCWP
-TSV remains elevated, Decrease FSV
-Decrease EF
-Wild PP

Question 7

Effect of tachycardia in severe AR

Answer 7

Tachycardia reduced diastole and time for regurgitation

Question 8

Which is better tolerated, MR or AR?

Answer 8

Severe AR

AR is well tolerated for years before symptoms develop.

In addition, in AI, the increase in LA pressure and PCWP requires that the volume overload surpasses the compliance of the LV then the compliance of the LA, whereas in MR, only surpassing the compliance of the LA is necessary.

Question 9

A mid-diastolic and late diastolic apical rumble in AR

Answer 9

Severe AR impinging on the anterior leaflet of the mitral valve or the free LV wall

Question 10

What happens to the gradient and AVA of AS in the presence of severe AR?

Answer 10

Gradient - overestimate due to increase in flow
AVA - underestimate if nest FSV is used, remember FVS is 50% if the TSV, the other 50% ay RV