Aortic regurgitation

Question 1

What is aortic regurgitation?

Answer 1

Reflux of blood from the aorta through the aortic valve into the left ventricle during diastole.

Question 2

Acute causes of aortic regurgitation?

Answer 2

Infective endocarditis and aortic dissection are the most common causes of aortic regurgitation.

Question 3

Chronic causes of aortic regurgitation?

Answer 3

Valve diseases i.e. Marfan’s disease, rheumatic causes e.g. rheumatoid arthritis and antiphospholipid syndrome.

Question 4

Clinical features of acute aortic regurgitation?

Answer 4

Sudden cardiovascular collapse

Pulmonary oedema

Pallor

Sweating

Peripheral vasoconstriction

Question 5

Clinical features of chronic aortic regurgitation?

Answer 5

Usually significant symptoms occur late, don’t usually develop until left ventricular failure develops.

Orthopnea - shortness of breath that occurs while lying flat and is relieved by sitting or standing.

Question 6

Examination finding of aortic regurgitation?

Answer 6

High-pitched early diastolic murmur best heard at left sternal edge in the 4th intercostal space with patient leaning forward and breath held on expiration.

Question 7

Investigations for aortic regurgitation?

Answer 7

ECG

CXR

Echocardiogram = definitive investigation in diagnosis and quantification of AR severity.

Question 8

Medical management of aortic regurgitation?

Answer 8

Treat underlying cause if appropriate

ACE inhibitors are useful in individuals with chronic severe aortic regurgitation and heart failure.

Beta blockers may slow aortic dilation in Marfan’s patients

Question 9

Surgical management of aortic regurgitation?

Answer 9

Indicated in symptomatic patients, and in asymptomatic patients when left ventricular function begins to deteriorate.

Involves valve replacement