Aortic Regurgitation Flashcards
If both AS and AR is present what is the likely predominant lesions
AS
Acute causes of AR
IE
Prosthetic valve failure
Aortic dissections
ruptured sinus of Valsalva
acute rhematic fever
Chronic cause of AR
Bicuspid AV
IE
Ankylosing spondylitis
Marfans syndrome
dilated aortic root
syphilis
Rheumatic heart disease
How might AR present
SOB
Pulmonary oedema
Cardiac failure
back pain (dissection)
Fever (IE)
PND
noctural angina
Clinical signs of AR not on auscultation
Collapsing pulse
Wide pulse pressure
Displaced laterally thrusting (volume overload) apex beat
Eponymous signs of AR
Corrigan’s - dancing carotid
Quinkes - Nail bed pulsations
De Mussets - head bobbing
Mullers - uvula pulsations
Traubes - pistol shot over femoral art.
Sign on auscultation of AR?
Early diastolic murmur heard leaning forward on expiration
may have aortic flow murmur
Austin flint murmur
Does the degree of murmur indicate severity in AR?
No, actually the shorter the murmur the more severe. This is due to rapid equalisation of pressure of the AV with more severe regurgitation
why may an aortic flow murmur be present in AR?
Increased EDV within the LV due to regurgitant flow
this is then forced through the AV in systole
What is an Austin Flint murmur
Mid-diastolic murmur heard due to regurgitant flow impeding the opening of the anterior cusp of the mitral valve.
Causes of collapsing pulse
AR
High output states (fever/ pregnancy/ anaemia)
PDA
Pagets
Differentials of AR
Pulmonary regurgitation
What are the causes of dilated aortic root
Marfans syndrome
Syphilis
Bicuspid AV
Ank Spond
HTN
EDS
What are the investigations of AR?
ECG
Echocardiogram
coronary angiogram
cardiac MRI
If thinking IE 3x BCs
What is the medical management of AR?
ACEIs
Diuretics
Typically reserved for chronic asymptomatic AR
What is the surgical option for management of AR?
Aortic valve replacement
What are the indications for surgical management of AR
DEADS
Dilated LV >55cm
EF <50%
Any other cardiac surgery
Dilated aortic root (>55cm) (Marfans >45cm, Bicuspid >50cm)
Symptomatic
Complication of AR
Heart failure
endocarditis
How is severity graded in AR clinically?
Heart failure
Cardiomegaly
Wide pulse pressure
Short murmur
Present a case of typical AR
Today I examined Mr Smith. On examination MR Smith has a collapsing pulse, displaced lateral apex beat and a early diastolic murmur heard loudest on expiration. These findings would be most consistent with aortic regurgitation. I did not observe any eponymous signs in this examination but would want to check for nail bed pulsations and uveal pulsation. There was/was not any peripheral stigmata of endocarditis such as splinter haemorrhages or janeway lesions. There was/ was not evidence of cardiac decomposition in that there was no peripheral oedema, raised JVP or pulmonary oedema.
Therefore, to summaries. This patient has sign of aortic regurgitation. I suspect in this patient the underlying cause my be XXX. Differential diagnosis include XXX
Other than AR how else might marfans effect the CVS
Aortic dissection
MV prolapse
Dilated aoritc root
mitral annular calcification
Genetics of marfans syndrome
Autosomal dominant
mutation in fibrillin 1 gene on chromosome 15
