Aortic Regurgitation

Question 1

Chronic causes:

• BAV can cause this. What is it?
• Any disease process that leads to aortic root dilation will cause the aortic valve annulus to stretch, resulting in failure of the leaflets to coapt properly in diastole and, ultimately, aortic regurgitation. What diseases could cause this?
• Read the rest?

Acute causes:
- What infection of the heart can affect all the valves?

Answer 1

Bicuspid aortic valve (BAV) is an inherited form of heart disease in which two of the leaflets of the aortic valve fuse during development in the womb resulting in a two-leaflet valve (bicuspid valve) instead of the normal three-leaflet valve (tricuspid).

Marfan’s syndrome or aortic dissection

Inflammatory - SLE, RA, rheumatic heart disease
HTN

Infective endocarditis
Aortic dissection

Question 2

Symptoms

LVF symptoms?? - 3

What does their heart beat feel like for them?

Answer 2

SOB
Orthopnoea
PND

Sense of pounding heart beat

Question 3

Signs:

What type of murmur do you hear?
Where can it be heard?
What type of murmur could you hear if severe?
Between what heart sounds does this murmur occur?
What type of pulse may you feel on the radial artery?
Why do they get a bounding pulse?
What type of pulse pressure could they have, narrow or wide and why?

• What do you ask the patient to do to accentuate it?
• Do you use the D or B?

Answer 3

High pitched (or blowing) early diastolic murmur

Aortic and left sternal area

Austin flint - The Austin Flint murmur is caused by the aortic regurgitation jet abutting the left ventricular endocardium, resulting in the generation of a low-pitched diastolic rumbling.

Between S2 and S1 i.e diastolic

Collapsing pulse

The left lower chamber of the heart widens (dilates) and the heart beats very strongly (bounding pulse) to compensate for this,

Wide pulse pressure - This regurgitant flow causes a decrease in the diastolic blood pressure in the aorta, and therefore a widening of the pulse pressure. - THERE IS LESS BLOOD RUSHING INTO THE CHAMBER SO THERE IS LESS PRESSURE AGAINST THE VALVES AS THEY CLOSE.

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Lean forward
Hold the breath in expiration

Using the diaphragm

Question 4

Ddx diastolic murmur

Answer 4

Aortic regurgitation
Aortic dissection - causing above
Mitral stenosis
Right sided valve disease

Question 5

Investigations
Echo is diagnostic

What do you find in an:
ECG
CXR

What could be used to visualise aortic root in Marfan’s syndrome?

Answer 5

LVH

LVH
Dilated ascending aorta

Multi-slice CT

Question 6

Management:

Answer 6

Regular echo
6 monthly if severe
Every 2 yrs if mild-moderate
Surgery