Aortic regurgitation

Question 1

What are the features of aortic regurgitation?

Answer 1

Features

1. Early diastolic murmur: intensity of the murmur is increased by the handgrip manoeuvre
2. Collapsing pulse
3. Wide pulse pressure
4. Quinke’s sign (nailbed pulsation)
5. De Musset’s sign (head bobbing)
6. Mid-diastolic Austin-Flint murmur in severe AR - due to partial closure of the anterior mitral valve cusps caused by the regurgitation streams

Question 2

What are the valvular causes of aortic regurgitation?

Answer 2

1. rheumatic fever
2. infective endocarditis
3. connective tissue diseases e.g. RA/SLE
4. bicuspid aortic valve

Question 3

What are the aortic root disease causes of aortic regurgitation?

Answer 3

• aortic dissection
• spondylarthropathies (e.g. ankylosing spondylitis)
• hypertension
• syphilis
• Marfan’s, Ehler-Danlos syndrome

Question 4

What are the clinical features of symptomatic disease in aortic stenosis?

Answer 4

1. chest pain
2. dyspnoea
3. syncope

Question 5

What murmur is heard in aortic stenosis?

Answer 5

• An ejection systolic murmur (ESM)
• This is decreased following the Valsalva manoeuvre
  
  • due to decreased preload

Question 6

What are the features of severe aortic stenosis?

Answer 6

• narrow pulse pressure
• slow rising pulse
• delayed ESM
• soft/absent S2
• S4
• thrill
• duration of murmur
• left ventricular hypertrophy or failure

Question 7

What are the causes of aortic stenosis?

Answer 7

• degenerative calcification (most common cause in older patients > 65 years)
• bicuspid aortic valve (most common cause in younger patients < 65 years)
• William’s syndrome (supravalvular aortic stenosis)
• post-rheumatic disease
• subvalvular: HOCM

Question 8

What is the management of aortic stenosis?

Answer 8

Asymptomatic

• observe the patient

Surgery

• if asymptomatic but valvular gradient > 40 mmHg and with features such as left ventricular systolic dysfunction then consider surgery
• if symptomatic then valve replacement
• cardiovascular disease may coexist. For this reason an angiogram is often done prior to surgery so that the procedures can be combined
• balloon valvuloplasty is limited to patients with critical aortic stenosis who are not fit for valve replacement