Aortic Regurgitation Flashcards
Causes of acute aortic regurgitation (AR).
Infective endocarditis
Ascending aortic dissection
Chest trauma
Causes of chronic AR.
Congenital (bicuspid)
Idiopathic dilation of the aorta
Calcific degenerations
Rheumatic disease
Marfan syndrome
SLE
Hypertension
Syphilitic aortitis
Progression of aortic regurgitation.
Increased volume load on the left ventricle leads to LV dilation and LV hypertrophy. This will ultimately lead to heart failure.
Symptoms of AR.
Exertional dyspnoea and reduced exercise tolerance
Orthopnoea
PND
Palpitations
Angina
Syncope
Signs of AR.
Collapsing pulse
Wide pulse pressure
Displaced hyperdynamic apex beat
High pitched early diastolic murmur (heard over left sternal edge 4th intercostal) It’s best heard in expiration with patient sat forward.
Corrigan’s sign - a collapsing pulse and is a rapidly appearing and disappearing pulse at carotid as the blood is pumped out by the ventricles and then immediately flows back through the aortic valve back into the ventricles.
de Musset’s sign - head nodding with each heart beat
Quincke’s sign - capillary pulsation
Duroziez’ sign - systolic murmur in femoral artery if finger compressing 2cm proximally.
Pistol shot sound over femoral artery.
Investigations in AR.
ECG
CXR
Echocardiogram (diagnostic)
Cardiac catheterisation - assess severity of lesion and anatomy of aortic root etc…
ECG changes in AR.
Left ventricular hypertrophy.
Tall R waves and deeply inverted T waves in left-sided chest leads and deep S waves in the right-sided leads.
CXR findings in AR.
Cardiomegaly
Dilated ascending aorta
Pulmonary oedema
LV enlargement
Calcifications of aorta or aortic valve.
Why is echocardiogram done in AR?
To assess AR
To diagnose AR
To assess severity of regurgitation and assess rest of the heart.
Management of AR.
Main goal is medical therapy to reduce systolic HTN.
ACEi are helpful to reduce afterload ad slow rate of LV dilation.
Echo is done every 6-12 months to monitor.
Indications of surgery in AR. (valve replacement)
Chronic AR with;
Symptomatic severe AR
Asymptomatic severe AR with evidence of early LV systolic dysfunciton ( EF < 50% or LVESD > 5 cm or LVEDD > 7 cm)
Severe AR with enalrged aortic root > 5.5 cm (or > 4.5 cm in Marfan or bicuspid aortic valve)
Murmur of AR
Early diastolic, soft murmur.
Can also cause an “Austin-Flint” murmur.
This is heard at the apex and is an early diastolic “rumbling” murmur. This is caused by blood flowing back through the aortic valve and over the mitral valve causing it to vibrate.
