Aortic regurgitation

Question 1

Aortic regurgitation

Answer 1

Reflux of blood from the aorta into the left ventricle during diastole. Also known as aortic insufficiency.

Question 2

Aortic regurgitation pathophysiology?

Answer 2

leads to left ventricular dilation, so increased end diastolic volme and increased stroke volume, leads to high volume collapsing pulse.

Question 3

Aortic regurgitation risk factors?

Answer 3

Aortic valve leaflet abnormalities or damage (bicuspid aortic valve, infective endocarditis, rheumatic fever, trauma).

Aortic root/ascending aorta dilatation (systemic hypertension, aortic dissection),

aortitis,

arthritides (e.g. rheumatoid arthritis, seronegative arthritides),

connective tissue disease (e.g. Marfan’s, Ehlers-Danlos)

Question 4

Aortic regurgitation epidemiology?

Answer 4

Chronic AR begins in late 50s, most frequently seen in >80s

Question 5

Aortic regurgitation symptoms of chronic conditon?

Answer 5

initially asymptomatic, develop symptoms of heart failure (e.g. exertional dyspnoea, orthopnoea, fatigue).

Question 6

Aortic regurgitation dyspnoea?

Answer 6

difficult or laboured breathing.

Question 7

Aortic regurgitation orthopnoea?

Answer 7

shortness of breath (dyspnea) that occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair.

Question 8

Aortic regurgitation symptoms of acute condition?

Answer 8

sudden cardiovascular collapse as left ventricle cannot adapt to the rapid increase in end-diastolic volume, leads to chest or back pain due to aortic dissection.

Question 9

Aortic regurgitation signs (6)?

Answer 9

collapsing pulse,

wide pulse pressure,

thrusting and heavy apex beat,

end diastolic murmour over the aortic valve region.

Ejection systolic murmour,

Austin Flint mid-diastolic murmour heard over the apex

Question 10

Aortic regurgitation collapsing pulse?

Answer 10

Question 11

Aortic regurgitation ejection systolic murmur?

Answer 11

Question 12

Aortic regurgitation investigations?

Answer 12

CXR (cardiomegaly, dilation of ascending aorta, signs of pulmonary oedema)

ECG (may show left ventricular hypertrophy i.e. deep S in V1/2, tall R in V5/6 inverted T in lead 1, aVL, V5/6, left axis deviation)

Echocardiogram (may show underlying cause of aortic root dilation or bicuspid aortic valve, Dopple echo can show AR and severity)

Question 13

Aortic regurgitation valve locations?

Answer 13

Question 14

Aortic regurgitation CXR?

Answer 14

Question 15

Aortic regurgitation ECG?

Answer 15