Aortic Regurgitation Flashcards

1
Q

what is the definition of aortic regurgitation (aortic insufficiency)

A

reflux of blood from aorta to LV in diastole

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2
Q

what is the aetiology of aortic regurgitation

A
1. aortic valve abnormalities/damage
bicuspid aortic valve
infective endocarditis
rheumatic fever
trauma
2. aortic root dilation
systemic HTN
aortic dissection
aortitis
arthritides (joint inflammation)
CTD (marfans/ehlers danlos syndrome)
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3
Q

what is the consequence of aortic regurgitation

A

reflux of blood from aorta into LV in diastole:
LV dilation, increased end-diastolic volume in the heart, increased stroke volume
increased stroke volume and low end-diastolic pressure in aorta may explain collapsing pulse and wide PP
in acute AR, LV cannot adapt to rapid increase in end-diastolic volume

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4
Q

what is the epidemiology of aortic regurgitation

A

chronic AR begins in 50y/os

most frequently seen in >80s

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5
Q

what is the history of chronic aortic regurgitation

A

initially asymptomatic
symptoms of HF, exertional dyspnoea, orthopnea, fatigue
angina

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6
Q

what is the history of severe acute aortic regurgitation

A

sudden cardiovascular collapse

symptoms related to aetiology (aortic dissection-sudden central ‘tearing’ pain)

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7
Q

what are the examination findings in aortic regurgitation

A
  1. collapsing pulse
  2. WPP
  3. thrusting and heaving displaced apex beat
  4. early distolic murmur (aortic manoeuvre on expiration)
    an ejection systolic murmur might be heard due to increased flow across the valve
  5. austin flint mid-diastolic murmur over apex
    flow back into LV hits the anterior cusp of the mitral valve which produces a physiological mitral stenosis
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8
Q

what are the rare examination findings in aortic regurgitation

A

quinckes sign-visible pulsations in nail bed
de mussets sign-head nodding in time with pulse
mullers sign-visible pulsations of the uvula

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9
Q

what are the investigations in aortic regurgitation

A
  1. CXR (cardiomegaly, dilation of ascending aorta, signs of pulmonary oedema)
  2. ECG
    LVH
    -deep S wave in V1-2
    -tall R wave in V5-6
    -inverted T waves in I, aVL, V5-6
    -LAD
    3 Echo
    -2D and M-mode for underlying cause (biscupid aortic valve) and severity of AR
    4 doppler for detecting AR and assessing severity
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10
Q

what is the most common cause of AR in developing countries

A

rheumatic fever

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11
Q

what is the most common cause of AR in developed countries

A

bicuspid aortic valve

aortic root dilation

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12
Q

what can causes of AR be split into

A

valvular

non-valvular

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13
Q

what are three valvular causes of AR

A

1 congenital bicuspid aortic valve
2 infective endocarditis
3 rheumatic fever

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14
Q

what could be a valvular and non-valvular cause of AR

A

ankylosing spondylitis

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15
Q

what are three causes of non-valvular AR

A

1 HTN
2 aortic dissection
3 CTDs (marfans pr ehlers danlos)

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16
Q

how does the murmur in AR indicate the severity

A

mild AR - early diastolic mumur

severe AR - pansystolic murmur