aortic regurgitation Flashcards
main causes
- endocarditis
- Marfan syndrome
- rheumatic fever
chronic causes
- syphilis
- hypertension (severe)
- osteogenesis
what is it
reflux of blood from the aorta through the aortic valve into the left ventricle during diastole
what happens to maintain cardiac output
left ventricle size is enlarged so enough blood is pumped into the aorta
what happens to diastolic blood pressure
drops
what does enlarged left ventricle require more of
oxygen
so cardiac ischaemia develops
when do symptoms occur
late and not until left ventricular failure occurs
symptoms
- pounding of heart
- angina pectoris
- SOB
signs
- pulse bounding or collapsing
- Quincke’s sign
- apex beat displaced
- early diastolic murmur
what is Quincke’s sign
capillary pulsation in the nail beds
what is de Musset’s sign
head nodding with each heart beat
what investigation should be done
- CXR
- ECG
- echo
- cardiac catheterisation
what is seen on CXR
- left ventricular enlargement
- dilatation of ascending aorta
- aorta is calcified (in syphilis)
what is seen on ECG
- left ventricular hypertrophy
- tall R waves
- inverted T waves
- deep S waves
- sinus rhythm
what is seen on echo
- vigorous cardiac contraction
- dilated left ventricle
- aortic root enlarged
- diastolic fluttering of mitral valve leaflets
how is severity assessed
colour Doppler
what can be done to provide additional information
transoesophageal echocardiography
what is cardiac catheterisation required to assess
CAD in patients requiring surgery
treatment for acute aortic regurgitation
vasodilators and inotropes
what are ACE inhibitor useful for
patients with left ventricular dysfunction
what drug be careful for in Marfan
beta blockers as may slow aortic dilatation
when is surgery performed
before severe symptoms as they occur after myocardial failure
when is surgery indicated
- severe aortic regurgitation
- symptomatic patients
- those undergoing CABG or surgery of ascending aorta
what is used for surgery
- mechanical prostheses
- tissue valves
