Aortic Regurgitation

Question 1

What does aortic regurgitation lead to.

Answer 1

Regurgitation leads to an increase in LV end-diastolic pressure.

Question 2

What does an increase in LV end-diastolic pressure lead to. (2)

Answer 2

LV dilatation.

LV hypertrophy.

Question 3

What are the causes of aortic regurgitation. (8)

Answer 3

Rheumatic fever. 
Endocarditis. 
Hypertension.
Atherosclerosis. 
Marfan's syndrome. 
Syphilis. 
Seronegative arthritis. 
Aortic dissection.

Question 4

What are the symptoms of aortic regurgitation. (7)

Answer 4

Exertional dyspnoea. 
Arrhythmias. 
Orthopnoea. 
Paroxysmal nocturnal dyspnoea. 
Angina. 
Palpitations.
Syncope.

Question 5

What are the clinical signs of aortic regurgitation. (11)

Answer 5

Heaving displaced apex beat.
Diastolic thrill.
3rd heart sound.
Wide pulse pressure.
Large volume collapsing ‘waterhammer’ pulse.
Early diastolic, high-pitched murmur (heard best at lower left sternal edge, patient sitting forward).
Corrigan’s sign.
Quincke’s sign.
Traube’s sign.
De Musset’s sign.
Possibly: mid diastolic murmur heard best at the apex (Austin-Flint murmur).

Question 6

What is Corrigan’s sign.

Answer 6

Visible carotid pulsations.

Question 7

What is Quincke’s sign.

Answer 7

Capillary pulsations in the nail bed.

Question 8

What is Traube’s sign.

Answer 8

‘Pistol shots’ over the femoral arteries.

Question 9

What is De Musset’s sign.

Answer 9

Head nodding in time with the pulse.

Question 10

What is an Austin-Flint murmur.

Answer 10

Mid diastolic murmur heard best at the apex.

Question 11

What is seen on the ECG of a patient with aortic regurgitation. (2)

Answer 11

LV hypertrophy and strain.

Left axis deviation.

Question 12

What are the acute causes of AR. (3)

Answer 12

Infective endocarditis.
Ascending aortic dissection.
Chest trauma.

Question 13

What are the chronic causes of AR. (12)

Answer 13

Congenital. 
Connective tissue disorders (Marfan's, Ehlers-Danlos).
Rheumatic fever.
Takayasu artertitis.
Rheumatoid arthritis.
SLE.
Pseudoxanthoma elasticum.
Appetite suppressants.
Seronegative arthritides (ankylosing spondylitis, Reiter's syndrome, psoriatic arthropathy).
Hypertension.
Osteogenesis imperfecta.
Syphilitic aortitis.

Question 14

What is Duroziez’s sign.

Answer 14

It is in the groin.
A finger compressing the femoral artery 2cm proximal to the stethoscope gives a systolic murmur.
If 2cm distal, it gives a diastolic murmur as blood flows backwards.

Question 15

What is the indication of an Austin-Flint murmur.

Answer 15

Severe AR.