Aortic regurgitation

Question 1

What are the causes of acute aortic regurgitation?

Answer 1

Cusp rupture.
Connective tissue disorders, e.g. Marfan’s syndrome.
Aortic dissection.
Perforation secondary to infection.

Question 2

What are the causes of chronic aortic regurgitation?

Answer 2

Rheumatoid arthritis.
Ankylosing spondylitis.
Syphilis.

Question 3

What are the symptoms of aortic regurgitation?

Answer 3

Dyspnoea.
Angina.
Heart failure.

Question 4

What are the signs of aortic regurgitation?

Answer 4

Waterhammer pulse.
Wide pulse pressure.
Traube’s sign: a ‘pistol shot’ heard over the femoral artery.
De Musset’s sign: head nodding in time with heart beat.
Quincke’s sign: pulse felt in the nail.
Signs of systemic disease.

Question 5

Describe the murmur of aortic regurgitation.

Answer 5

Decrescendo early diastolic murmur.

Question 6

What investigations should be performed for suspected aortic regurgitation, and what findings would you expect?

Answer 6

ECG: left ventricular hypertrophy.
CXR: may see cardiomegaly and pulmonary oedema if patient has heart failure.
ECHO: confirms diagnosis, allows severity and aortic root to be assessed.

Question 7

What is the conservative treatment for aortic regurgitation?

Answer 7

Manage cardiovascular risk factors, e.g. smoking cessation.

Question 8

What is the medical treatment for aortic regurgitation?

Answer 8

Manage heart failure by following NICE guidelines.

Question 9

What is the surgical treatment for aortic regurgitation?

Answer 9

Valve replacement is the treatment of choice.

Question 10

What are the complications of aortic regurgitation?

Answer 10

Heart failure
Arrhythmia
Infective endocarditis