Aortic Regurgitation

Question 1

What is it?

Answer 1

When blood is able to flow back through the aortic valve from the aorta into the left ventricle

Question 2

What causes it? (5)

Answer 2

1. Congenital Bicuspid valve 2. Rheumatic fever 3. Infective endocarditis 4. Collagen Vascular Diseases 5. Degenerative valve disease e.g Calcification

Question 3

Is it common?

Answer 3

2-30% prevalence in over 65’s but severity ranges

Question 4

Who does it affect?

Answer 4

Peak age of presentation is 40-60 years old

Question 5

Risk factors (9)

Answer 5

SLE, Marfan’s, Ehlers Danlos, Turner’s Syndrome, Advanced Syphilis, Ankylosing Spondylitis, Reactive arthritis, Aortic dissection, Infective endocarditis

Question 6

Symptoms (6)

Answer 6

Exertional dyspnoea, orthopnoea (sleeping with multiple pillows), Paroxysmal Nocturnal Dyspnoea, Palpitations, angina, syncope

Question 7

Signs (6)

Answer 7

Congestive cardiac failure, collapsing pulse, wide pulse pressure, early diastolic murmur, carotid pulsation, diastolic murmur in groin

Question 8

What bloods would you do? (7)

Answer 8

FBC, U&E, LFT, CRP, BNP, Lipids, Glucose

Question 9

Other investigations

Answer 9

ECG, ECHO, Chest xray, Cardiac MRI, Cardiac catheterisation to measure pulse pressure

Question 10

What is the treatment? (4)

Answer 10

TAVI, ACE inhibitors to reduce hypertension, Vasodilators, Inotropic agents

Question 11

Is there a good prognosis for aortic regurgitation?

Answer 11

Patients with severe acute condition have poor prognosis due to haemodynamic instability, once symptoms appear mortality is 10-20% per year