Aortic Regurgitation

Question 1

Define aortic regurgitation.

Answer 1

Aortic regurgitation (AR) is the diastolic leakage of blood from the aorta into the left ventricle. It occurs due to inadequate coaptation of valve leaflets resulting from either intrinsic valve disease or dilation of the aortic root. It can remain asymptomatic for decades before patients present with irreversible myocardial damage.

Question 2

Explain the aetiology/risk factors of aortic regurgitation.

Answer 2

AR can be caused by primary disease of the aortic valve leaflets or dilation of the aortic root. In developing countries, rheumatic heart disease (rheumatic fever during which the heart valves are damaged) is the most common cause, but congenital bicuspid aortic valve and aortic root dilation account for most of the cases in developed countries.

Question 3

Summarise the epidemiology of aortic regurgitation.

Answer 3

AR is not as common as aortic stenosis and mitral regurgitation. One US study showed a prevalence of 13% in men and 8.5% in women with most being trace or mild; a prevalence of 15.6% was reported in African-Americans. Prevalence increases with age in both genders.

Question 4

Recognise the presenting symptoms of aortic regurgitation.

Answer 4

Dyspnoea
Fatigue
Weakness
Orthopnoea
Paroxysmal nocturnal dyspnoea
Pallor

Question 5

Recognise the signs of aortic regurgitation on physical examination.

Answer 5

Mottled extremities
Rapid and faint peripheral pulse
Jugular venous distension
Basal lung crepitations
Altered mental status
Urine output <30 mL/hour
Soft S1
Soft or absent A2
Collapsing (water hammer or Corrigan’s) pulse
Cyanosis
Tachypnoea
Displaced, hyperdynamic apical impulse

Question 6

Identify appropriate investigations for aortic regurgitation and interpret the results.

Answer 6

ECG
CXR
Echo
Colour flow Doppler
Pulsed wave Doppler
Continuous wave Doppler