Aortic regurgitation Flashcards
Define:
Reflux of blood from the aorta to the left ventricle during diastole due to a weakened aortic valve.
a.k.a aortic insufficency
Aetiology:
The improper closure of the valve leads to blood flowing back into the left ventricle leading to left ventricular abnormalities such as hypertrophy and enlargement.
Risk factors for valve abnormalities or damage:
- bicuspid aortic valve (there is more pressure on the leaflets as this should be a tricuspid valve)
- Infective endocarditis
- rheumatic fever (calcification of the valve may mean that they do not close properly)
- trauma
- age
Risk factors for aortic root or ascending aorta dilation:
systemic hypertension
aortic dissection
aortitis
Arthritis (rheumatoid and seronegative)
Connective tissue disorders such as Marfan’s and EH
Oestogenesis imperfecta
Epidemiology:
Usually begins in the 50s
Most patients that present are in their 80s
Symptoms:
initially will be asymptomatic
Symptoms of heart failure (orthopnea, exertional dysponea and fatigue)
Syncope
palpitations
CCF
Angina
Signs:
Collapsing pulse
Wide pulse pressure (there may be 20mmHg between the two arms)
Thrusting and heaving displaced apex beat
Early diastolic murmur which is heard more clearly when sitting forward and exhaling
Mid-diastolic murmur over apex
rare signs - Quincke’s (throbbing in the nail bed) and De Musset’s (nodding in time with the pulse)
Investigations:
CXR - cardiomegaly, dilation of the ascending aorta + signs of pulmonary oedema.
ECG
Echo ( may show cause, effects and severity if doppler echo)
cardiac catherisation with angiography
what changes would you see on an ECG?
Left ventricular hypertrophy
Deep S in V1/2
Tall R in V5/6
Inverted T waves in lead I, avl and V5/6
LEFT AXIS DEVIATION