Aortic Regurgitation

Question 1

What is aortic regurgitation?

Answer 1

Reflux of blood from the aorta into the left ventricle during DIASTOLE

Question 2

What is aortic regurgitation also known as/called?

Answer 2

Aortic insufficiency

Question 3

What are the 2 groups of causes of aortic regurgitation?

Answer 3

Aortic valve leaflet abnormality/damage

Aortic root/ascending aorta dilation

Question 4

Examples of aortic valve leaflet abnormality/damage causes of aortic regurgitation?

Answer 4

Bicuspid aortic valve (congenital)
Infective endocarditis
Rheumatic fever
Trauma

Question 5

Dilation of aortic root/ascending aorta causes of aortic regurgitation?

Answer 5

Systemic hypertension
Aortic dissection
Aortitis
Arthritides 
Marfan's
(other rarer stuff)

Question 6

When does chronic AR begin and in what age group is it most frequently documented?

Answer 6

Chronic AR often begins in late 50s

Documented most frequently in >80s

Question 7

Presentation of AR (chronic and severe acute)?

Answer 7

Chronic AR

• initially asymptomatic
• symptoms of heart failure start to appear (exertional dyspnoea, orthopnoea, fatigue)

Severe acute
- sudden cardiovascular collapse

There may be symptoms associated with the cause e.g. tearing central chest pain from aortic dissection

Question 8

3 standard signs of AR on examination?

Answer 8

• Collapsing ‘water-hammer’ pulse
• Wide pulse pressure
• Thrusting and heaving displaced apex beat (volume-loaded)

Question 9

More specific exam-oriented signs of AR on examination? (auscultation + murmur site/position)

Answer 9

• Traube’s sign ‘pistol shot’ auscultation of femoral arteries
• Early diastolic murmur at lower left sternal edge, best heard with patient sitting forward with breath held in expiration

Question 10

Investigations for AR?

Answer 10

CXR
ECG
Echo
Cardiac catheterisation with angiography

Question 11

CXR signs of AR?

Answer 11

Cardiomegaly
Dilation of ascending aorta
Pulmonary oedema (due to left heart failure)

Question 12

ECG signs of AR?

Answer 12

Signs of left ventricular hypertrophy

• deep S wave (V1-2)
• tall R wave (V5-6)
• inverted T waves (I, aVL, V5-6)
• left axis deviation

Question 13

Potential echocardiogram signs of AR?

Answer 13

• Underlying cause (aortic root dilation or bicuspid aortic valve)
• Effects of AR (left ventricular dilation/dysfunction)

Question 14

How is AR detected and severity assessed? (same investigation)

Answer 14

Doppler echocardiography

Question 15

Why is follow-up echocardiogram necessary in AR?

Answer 15

Serial measurement of LV size and function

Question 16

Why is cardiac catheterisation with angiography sometimes indicated in AR?

Answer 16

If there is uncertainty about the functional state of the ventricle or the presence of coronary artery disease