Aortic Regurgitation Flashcards
Define Aortic Regurgitation?
Reflux of blood from the aorta into the left ventricle during diastole
Also known as aortic insufficiency
What are the causes of aortic regurgitation?
Aortic valve leaflet abnormalities or damage
Aortic root/ascending aortic dilation
What are the causes of Aortic Valve Leaflet abnormalities or damage?
Bicuspid aortic valve
Infective endocarditis
Rheumatic fever
Trauma
What are the causes of Aortic root/ascending aortic dilation?
Systemic hypertension
Aortic Dissection
Aortitis
Arthritides (e.g. rheumatoid arthritis, seronegative arthritides)
Connective tissue disease (e.g. Marfan’s, Ehlers- Danlos)
Pseudoxanthoma Elasticum
Osteogenesis Imperfecta
What is the pathophysiology of Aortic Regurgitation?
Reflux of blood into the left ventricle results in left ventricular dilation
This means increased end diastolic volume and increased stroke volume
The combination of increased stroke volume and low-end diastolic AORTIC pressure may explain the high-volume collapsing pulse
What is the epidemiology of Aortic Regurgitation?
Chronic Aortic Regurgitation often begins in the late 50s
It is most frequently seen in patients > 80 yrs
What are the presenting symptoms of Chronic Aortic Regurgitation?
Initially asymptomatic
Later on, the patient may develop symptoms of heart failure (e.g. exertional dyspnoea, orthopnoea, fatigue)
What are the presenting symptoms of Severe Acute Aortic Regurgitation?
Sudden cardiovascular collapse
left ventricle can’t adapt to the rapid increase in end-diastolic volume
What are the symptoms of Aortic Regurgitation related to?
Aetiology
E.g. chest or back pain caused by Aortic Dissection
What are the signs of Aortic Regurgitation on examination?
Collapsing (water-hammer) pulse
Wide pulse pressure
Thrusting and heaving displaced apex beat
Early Diastolic Murmur over the aortic valve region
Austin Flint mid-diastolic murmur
Where is the Early Diastolic murmur heard best?
Left sternal edge when the patient is sitting forward with the breath held at the top of expiration
What might also be heard in Aortic Regurgitation?
An ejection systolic murmur may also be heard because of increased flow across the valve (due to increased stroke volume)
Where is the Austin Flint Mid-Diastolic murmur heard?
Over the apex
What is the Austin-Flint Mid-Diastolic murmur caused by?
Turbulent reflux hitting the anterior cusp of the mitral valve causing a physiological mitral stenosis
What are the rare signs of Aortic Regurgitation?
Quincke's Sign De Musset's Sign Becker's Sign Muller's Sign Corrigan's Sign Traube's Sign Duroziez's Sign Rosenbach's Sign Gerhard's Sign Hill's Sign
What is Quincke’s Sign?
Visible pulsation on nail bed
What is de Musset’s Sign?
Head nodding in time with the pulse
What is Becker’s Sign?
Visible pulsation of the pupils and retinal arteries
What is Muller’s Sign?
Visible pulsation of the uvula
What is Corrigan’s Sign?
Visible pulsation in the neck
What is Traube’s Sign?
Pistol shot (loud systolic and diastolic sounds) heard on ausculation of the femoral arteries
What is Duroziez’s Sign?
Systolic and diastolic bruit heard on partial compression of the femoral artery with the stethoscope
What is Rosenbach’s Sign?
Systolic pulsations of the liver
What is Gerhard’s Sign?
Systolic pulsations of the spleen
What is Hill’s Sign?
Popliteal Cuff Systolic Pressure exceeding brachial pressure by > 60 mm Hg
What investigations would you do for Aortic Regurgitation?
CXR
ECG
Echocardiogram
Cardiac Catheterisation with angiography
What might we see on a CXR for Aortic Regurgitation?
Cardiomegaly
Dilation of ascending aorta
Signs of pulmonary oedema (if accompanied by left heart failure)
What might we see on an ECG for Aortic Regurgitation?
May show left ventricular hypertrophy:
- Deep S in V1/2
- Tall R in V5/6
- Inverted T waves in lead I, aVL, V5/6
- Left axis deviation
What might we see on an Echocardiogram for Aortic Regurgitation?
May show underlying cause (e.g. aortic dilation, bicuspid aortic valve)
May show the effects of aortic regurgitation (e.g. left ventricular dilation, 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)
Why might we do Cardiac Catheterisation with Angiography for Aortic Regurgitation?
If there is any uncertainty about the functional state of the ventricle or the presence of coronary artery disease
