Aortic Regurgitation

Question 1

Pathophysiology

Answer 1

LV accommodated both SV and regurgitant vol:

1. Increased LV EDV and LV systolic pressure causes LV hypertrophy and dilatation
2. Increased myocardial O2 demand
3. Myocardial ischaemia
4. LV failure

Question 2

What are conditions of the aorta which can causes aortic regurgitation?

Answer 2

Dilated (marfans syndrome, HPT)

Connective tissue disorders

Question 3

What are the symptoms of aortic regurgitation?

Answer 3

Chronic:
Long asymptomatic phase
Dyspnoea on exertion

Acute:
Poorly tolerated as wall tension cannot acutely adapt

Question 4

What are the signs on clinical examination?

Answer 4

Pulse - large and collapsing
Hyperdynamic apex beat
Early diastolic murmur
Basal lung crepitations (sign of pul. oedema)
Cyanosis (acute AR)
Tachypnoea (sign of acute AR with pul. oedema)

Question 5

What investigations should be carried out?

Answer 5

ECG
CXR
Angiography 
Echo
Cardiac MRI

Question 6

What treatments are available?

Answer 6

Vasodilator therapy (delay timing for surgery)
Aortic valve replacement or repair

Question 7

What are problems with the leaflets of the valve which can cause aortic regurgitation?

Answer 7

Biscuspid aortic valve
Rheumatic heart disease
Infective endocarditis
Myxmatous degeneration

Question 8

What will an ECHO show with AR?

Answer 8

AV cusp anatomy (thickening, prolapse, vegetations, no. of cusps)
LV function, dilatation and hypertrophy
Doppler haemodynamic assessment of regurgitant flow

Question 9

What will a CXR show with AR?

Answer 9

Cardiomegaly