Aortic Regurgitation

Question 1

Define Aortic Regurgitation

Answer 1

Reflux of blood from aorta to LV during diastole

Question 2

Aetiology of Aortic Regurgitation

Answer 2

Most common (developed) = Congenital bicuspid aortic valve 
Aortic root dilation (Marfan's, aortitis in syphilis, Behçets, Takayasu's, reactive arthritis, ank spond)

Most common (Developing) = Rheumatic heart disease

Endocarditis, vegetations on valvular cusps

Question 3

Epidemiology of Aortic Regurgitation

Answer 3

Not as common as other vale diseases
M > F
Prevalence increases with age

Question 4

Symptoms of Aortic Regurgitation

Answer 4

Usually asymptomatic with symptoms of HF

Dyspnoea, fatigue, SOB (orthopnoea + PND)
Weakness
Pallor
Chest pain, wheeze, syncope

Severe acute AR -> sudden collapse

Question 5

Signs of Aortic Regurgitation on examination

Answer 5

Early diastolic murmur, heard best at left sternal edge + sitting forward + expiration 
Austin Flint murmur 
de Musset's sign 
Quincke's sign 
Collapsing/water-hammer pulse 
Wide pulse pressure 

Heaving displaced apex beat
Pallor
Mottled extremities
HF: raised JVP, peripheral oedema, hepatomegaly, basal lung creps, pink frothy sputum 
Tachypnoea, cyanosis

Question 6

Investigations for Aortic Regurgitation

Answer 6

Echo (doppler) - confirms AR + severity

ECG - non-specific:: T wave, LAD, conduction abnormal

CXR - cardiomegaly, ascending aorta dilation, pulmonary oedema

Cardiac catheterisation - aortic regurgitation (presence of CAD or unsure about functional state)