Aortic regurgitation Flashcards
What is aortic regurgitation?
reflux of blood from the aorta into LV during diastole.
AKA: aortic insufficiency
List 3 chronic causes of AR due to valve disease
Rheumatic heart disease (most common in developing world)
Bicuspid aortic valve (most common cause in young in HICs)
Calcific aortic valve (most common in old in HICs)
Connective tissue diseases e.g. RhA, SLE
List 5 causes of aortic root disease leading to chronic aortic regurgitation
Bicuspid aortic valve
Spondyloarthropathies: Ankylosing spondylitis
HTN
Syphilis
CTDs: Marfan’s, Ehlers-Danlos
What is acute AR most often caused by?
Valve disease: Infective endocarditis
Aortic root disease: Aortic dissection.
List 2 signs on examination of a patient with AR
Collapsing (water-hammer) pulse
Wide pulse pressure
Describe the murmur in AR
Early diastolic
Intensity increased by handgrip manouvre
What murmur is heard in severe AR?
Mid-diastolic Austin-Flint murmur
Due to partial closure of anterior mitral valve cusps caused by regurgitation streams
Where is the early diastolic murmur in AR best heard?
Left sternal edge when patient is sitting forward with breath held at top of expiration
List 4 eponymous signs seen in AR
Quincke’s: visible pulsation on nail bed
de Musset’s: head bobbing
Corrigan’s: carotid pulsation
Traube’s: pistol shot (loud systolic + diastolic sounds) on auscultation of femoral arteries
How should suspected AR be investigated?
Echo
Describe management of AR
Medical Mx of associated HF
Surgery:
Symptomatic patients with severe AR
Asymptomatic patients with severe AR with LV systolic dysfunction
What may be seen on CXR in AR?
Cardiomegaly
Dilatation of ascending aorta
Signs of pulmonary oedema (if accompanied by left heart failure)
What may an ECG show in AR?
May show LV hypertrophy:
Deep S in V1/2
Tall R in V5/6
Inverted T waves in lead I, aVL, V5/6
What may an echocardiogram in AR show?
Underlying cause (e.g. aortic root dilatation, bicuspid aortic valve)
Effects of AR (e.g. LV dilatation, fluttering of the anterior mitral valve leaflet)
Doppler echocardiogram can show AR + indicate severity
Repeat echos allow monitoring of progression (LV size + function)
Why would you perform Cardiac catheterisation with angiography in AR?
If any uncertainty about functional state of the ventricle or the presence of coronary artery disease
