Aortic Regurgitation Flashcards
define aortic regurgitation?
reflux of blood from the aorta into the left ventricle during diastole, due to weakened aortic valve Also known as aortic insufficiency
explain the aetiology and risk factors of aortic regurgitation?
aortic valve leaflet abnormalities or damage
- bicuspid aortic valve-> 2 leafelts fuse rather than having 3 leaflets infecting
- infective endocarditis
- rheumatic fever
- trauma
- age
aortic root/ ascending aortic diliation
- systemic hypertension
- aortic dissection
- aortitis
- Arthritides (e.g. rheumatoid arthritis, seronegative arthritides)
- Connective tissue disease (e.g. Marfan’s, Ehlers-Danlos) Syphilis
- Pseudoxanthoma elasticum, Osteogenesis imperfecta
describe the pathophysiology of aortic regurgitation
The abnormal backflow leads to pathologic- left ventricular enlargement and hypertrophy takes place to maintain a normal co
Summarise the epidemiology of aortic regurgitation
Chronic AR begins in late 50s
most frequently seen in patients over 80s
What are the presenting symptoms of aortic regurgitation?
Chronic AR
- initially asymptomatic
- later on patients develop symptoms of heart failure- exertional dysopnoea, orthopnea, fatigue
- palpitations, angina, and syncope, CCF
Severe acute AR
-Sudden caridovascular collapse ( left ventricle cannot adapt to increase in end- diastolic volume)
symptoms related to aetiology- chest or back pain caused by aortic dissection
What are the signs of aortic regurgitation on examination?
collapsing water hammer pulse ( feels like a strong rebound pulse)
wide pulse pressure
thrusting and heaving displaced apex beat
early diastolic murmur over the aortic valve region- heard better when patient sitting forward with breath held at the top of expiration-> intensity of murmur increased with hand grip manoeuvre
ejection systolic mrumur may be heard because of inreased flow across valve ( due to increased stroke volume)
Austin Flint- mid-diastolic murmur
- heard over apex
- caused by turbulent reflux hitting anterior cusp of mitral valve causing a physiological mitral stenosis
What are the rare signs associated with aortic regurgitation?
Quincke’s Sign - visible pulsation on nail bed
de Musset’s Sign - head nodding in time with the pulse
Becker’s Sign - visible pulsation of the pupils and retinal arteries
Muller’s Sign - visible pulsation of the uvula
Corrigan’s Sign - visible pulsation in the neck
Traube’s Sign - pistol shot (loud systolic and diastolic sounds) heard on auscultation of the femoral arteries
Duroziez’s Sign - systolic and diastolic bruit heard on partial compression of the femoral artery with the stethoscope
Rosenbach’s Sign - systolic pulsations of the liver
Gerhard’s Sign - systolic pulsations of the spleen
Hill’s Sign - popliteal cuff systolic pressure exceeding brachial pressure by > 60 mm Hg
What are the appropriate investigations for aortic regurgitation?
CXR
ECG
Echocardiogram- diagnostic
cardiac cathetirisation with angiography
What will a CXR show in aortic regurgitation?
cardiomegaly
dilation of ascending aorta
signs of pulmonary oedema ( if accompanied by left ventricular failure)
What can be seen on an ECG in aortic regurgitation?
May show left ventricular hypertrophy
Deep S in V1/2 (left side)
Tall R in V5/6 (right side)
Inverted T waves in lead I, aVL, V5/6
Left axis deviation
What can be seen on an Echo in aortic regurgitation?
May show underlying cause (e.g. aortic root dilatation, bicuspid aortic valve)
May show the effects of aortic regurgitation (e.g. left ventricular dilatation, fluttering of the anterior mitral valve leaflet)
Doppler echocardiogram can show AR and indicate severity
Repeat echos allow monitoring of progression (LV size and function)
How does cardiac cathetirisation with angiography help in aortic regurgitation?
If there is any uncertainty about the functional state of the ventricle or the presence of coronary artery disease
Helps assess severity of lesion, aortic root anatomy, LV function
