Aortic Regurgitation

Question 1

Define aortic regurgitation

Answer 1

Reflux of blood from aorta -> LV during diastole

Question 2

What are the causes/risk factors of aortic regurgitation?

Answer 2

Aortic valve
• Bicuspid aortic valve
• Infective endocarditis
• Rheumatic fever
• Trauma

Aortic root dilatation
• Hypertension
• Aortic dissection
• Aortitis
• Arthritides
• Connective tissue disorders
• Osteogenesis imperfecta

Question 3

What are the symptoms of aortic regurgitation?

Answer 3

• Asymptomatic
• Angina

Symptoms of heart failure
• SOBOE
• Orthopnoea
• Fatigue
• Paroxysmal nocturnal dyspnea

Question 4

What are the signs of aortic regurgitation?

Answer 4

• Collapsing water-hammer pulse
• Wide pulse pressure
• Displaced apex beat
• Early diastolic murmur at lower left sternal edge, sitting forward on expiration
• Austin-Flint murmur – mid-diastolic murmur at apex (regurgitant jet hitting LV)
• Quincke’s sign – visible pulsation in nailbeds
• deMusset’s sign – rhythmic head nodding
• Corrigan’s sign – visible pulsation in neck
• Traube’s sign – pistol shot femoral
• Duroziez’s sign – femoral bruits
• Müller’s sign – pulsation or bobbing of the uvula that occurs during systole
• Becker’s sign – presence of visible (through an ophthalmoscope) pulsation of retinal arteries

Question 5

What are the investigations for aortic regurgitation?

Answer 5

• ECG - may show non-specific ST-T wave changes, left axis deviation, or conduction abnormalities
• CXR - may show cardiomegaly
• echocardiogram - visualisation of the origin of regurgitant jet and its width; detection of cause of aortic valve pathology
• M-mode and 2-dimensional imaging - assessment of valvular anatomy, aortic root dilation, and left ventricular response to volume overload
• colour flow doppler - detection and quantification of regurgitant flow
• pulse wave doppler - detection and quantification of holodiastolic flow reversal