Aortic Regurgitation

Question 1

Define

Answer 1

Reflux of blood from aorta into left ventricle (LV) during diastole

Question 2

Epidemiology

Answer 2

chronic AR often begins in late 50s

Question 3

Causes

Answer 3

Acute

• Infective endocarditis
• Ascending aortic dissection
• Chest trauma

Chronic
􏰀 Congenital (bicuspid aortic valve)
􏰀 Connective tissue disorders (Marfan’s, Ehlers-Danlos)
􏰀 Rheumatic fever, Takayasu’s arteritis
􏰀 SLE, RhA
􏰀 Pseudoxanthoma elasticum
􏰀 Seronegative arthritis (e.g. ankylosing spondylitis)
􏰀 HTN

Question 4

Symptoms

Answer 4

nitially asymptomatic, later signs of HF
􏰀 Exertional dyspnoea
􏰀 Orthopnoea
􏰀 Paroxysmal nocturnal dyspnoea 􏰀 Palpitations, angina, syncope
Severe acute AR: sudden cardiovascular collapse

Question 5

Signs

Answer 5

􏰀 Collapse water-hammer pulse
􏰀 Wide pulse pressures
Laura Tan CARDIO 3
􏰀 High pitched early diastolic murmur
Heard best in expiration with pt sitting forward
􏰀 Displaced, hyper-dynamic apex bear
*Austin Flint murmur denotes severe AR
Over the apex, from turbulent reflux hitting anterior cusp of the mitral valve, causing a physiological mitral stenosis

􏰂 de Musset’s sign—head nodding in time with the pulse
􏰂 Muller’s sign—systolic pulsations of the uvula
􏰂 Corrigan’s sign—visible carotid pulsations
􏰂 Quincke’s sign—capillary nailbed pulsation in the fingers
􏰂 Traube’s sign—’pistol shot’ femorals, a booming sound
heard over the femorals
􏰂 Duroziez’s sign—to and fro diastolic murmur heard when
compressing the femorals proximally with the stethoscope

Question 6

Investigations

Answer 6

1. ECG
2. Chest x ray
3. Echo
4. CArdiac cath