aortic regurgitation Flashcards
definition of aortic regurg
reflux of blood from aorta into the L ventricle during diastole
also called aortic insufficiency
aetiollogy of aortic regurg
aortic valve leaflet abnormalities or damage
aortic root/ascending aorta dilation
chest trauma
SLE
appetite suppressants eg fenfluramine, phentermine
HTN
seronegative arthritides (ankylosing spondylitis, Reiter’s syndrome, psoriatic arthropathy),
reflux of blood into LV in disatole = LV dilation and increased end diastolic volume, and SV
combination of raised SV and low end-diastolic pressure in aorta = collapsing pulse and wide pulse pressure
In acute AR, the LV cannot adapt to the rapid increase in end-diastolic volume caused by regurgitant blood.
aortic valve leaflet abnormalities or damage = aortic regurg
bicuspid aortic valve
infective endocarditis
rheumatic fever
trauma
aortic root/ascending aorta dilation = aortic regurg
- systemic hypertension
- aortic dissection
- aortitis - syphilis, Takayasu’s arteritis
- arthritides - rheumatoid arthritis, seronegative arthritides
- marfan’s syndrome
- pseudoxanthoma elasticum
- ehlers-danlos syndrome
- osteogenesis imperfecta
epidemiology of AR
Chronic AR often begins in the late 50s,
documented most >80 years.
sx of AR
chronic
- asymptomatic initially
- HF - exertional dyspnoea, orthopnoea, fatigue
- PND
- occaisional angina
- palpitations
- CCF
severe acute = sudden CVS collapse
symptoms related to aetiology - chest or back pain in patients with aortic dissection
signs of AR
collapsing ‘water hammer’ pulse
wide pulse pressure
thrusting and heaving (volume loaded) displaced apex beat
Early diastolic murmur at lower left sternal edge, better heard with the patient sitting forward with the breath held in expiration. An ejection systolic murmur is often heard because of increased flow across the valve.
Austin Flint mid-diastolic murmur: Over the apex, from turbulent reflux hitting anterior cusp of the mitral valve and causing a physiological mitral stenosis.
signs from hyperdynamic pulse
signs from hyperdynamic pulse of AR
quinke’s sign
de Musset’s sign - head bobbing in time with pulse
Becker’s - visible pulsations of the pupils and retinal arteries
muller’s - visible pulsation of the uvula
corrigan’s - visible pulsation in neck (carotid)
traube’s - ‘pistol shot’ systolic and diastolic sounds) heard on auscultation of thefemoral arteries.
Duroziez’s sign: A systolic and diastolic bruit heard on partial compression of femoral artery with a stethoscope.
Rosenbach’s sign: Systolic pulsations of the liver
Gerhard’s sign: Systolic pulsations of the spleen.
Hill’s sign: Popliteal cuff systolic pressure exceeding brachial pressure by>60 mmHg.
Ix for AR
CXR
ECG
echo
cardiac catheterisation with angiography
CXR for AR
Cardiomegaly.
Dilation of the ascending aorta.
Signs of pulmonary oedema may be seen with left heart failure.
ECG for AR
May show signs of left ventricular hypertrophy (deep S wave in V1–2, tall R wave in V5–6,inverted T waves in I, aVL, V5–6and left-axis deviation).
exho for AR
2D echo and M-mode
- the underlying cause (e.g. aortic root dilation, bicuspid aortic valve)
- or the effects of AR (left ventricular dilation/dysfunction and fluttering of the anterior mitral valve leaflet).
Doppler echocardiography - detect AR and assess severity.
Periodic (annual) follow-up echocardiogram for serial measurements of LV size and function.
cardiac catheterisation with angiography for AR
If there is uncertainty about the functional state of the ventricle or the presence of coronary artery disease.
assess severity of lesion
anatomy of aortic root
other valve disease
