AORTIC REGURGITATION

Question 1

Causes (Acute)

Answer 1

IE, Acute RF, Aortic dissection, Failed prosthetic heart valve, MI

Question 2

Causes (chronic)

Answer 2

RHD, Bicuspid aortic valve, Marfan syndrome, Ehlers-Danlos syndrome, Rheumatoid arthritis, Ankylosing spondylitis, Reiter syndrome, SLE, Syphilis, Osteogenesis imperfecta

Question 3

Pathophysiology (2)

Answer 3

• Inadequate closure of aortic valve —> reflux of blood from aorta into LV during diastole —> increased LV volume load of left ventricle —> LV dilatation —>increased stroke volume and pulse pressure
• Eventually contraction of ventricle deteriorates —> left ventricular failure

Question 4

Symptoms (3)

Answer 4

• Asymptomatic for years
• Signs of LV failure (dyspnea, orthopnea, etc)
• Acute aortic regurgitation (medical emergency): cyanosis and shock

Question 5

Signs (6)

Answer 5

• Widened pulse pressure (increased systolic and decreased diastolic BP)
• Collapsing water-hammer pulse (Corrigan pulse)
• S3 added sound may also be present
• AR EDM: early diastolic murmur (increased when sitting forward and holding breath in expiration)
• Austin Flint murmur (mid-diastolic murmur) due to physiological mitral stenosis
• Signs of severe AR:
  
  • Quinckle pulse: pulsation in nailbed, blushing and blanching of nail capillaries
  • Head bobbing
  • Hill sign: popliteal systolic BP > brachial systolic BP by 60mmHg or more

Question 6

Diagnosis (3)

Answer 6

• CXR: LVH, dilated aorta
• ECG: LVH
• Echo to asses LV size and function and look for dilated aortic root

Question 7

Treatment (3)

Answer 7

• Acute AR (e.g. post-MI): medical emergency: emergent aortic valve replacement
• Symptomatic relief with nifepidine and ACE inhibitors
• Definitive treatment is aortic valve replacement