Aortic Regurgitation (AR)

Question 1

Definition of AR

Answer 1

• Diastolic leakage of blood from the aorta into the left ventricle

Question 2

Aetiology of AR

Answer 2

• Idiopathic age related weakness
• Rheumatic heart disease
• Congenital bicuspid valve
• Aortic root dilatation (i.e. Marfan’s syndrome, aortitis secondary to syphilis, ankylosing spondylitis, reactive arthritis)
• Endocarditis

Question 3

Signs and Symptoms of AR

Answer 3

• Early diastolic, soft murmur.
• Signs/symptoms include dyspnoea, fatigue, weakness, oethopnoea, PND, pallor, mottled extremities, rapid and faint peripheral pulse, collapsing pulse (Corrigan’s pulse), cyanosis, tachypnoea, raised JVP, basal lung crepitations, altered mental status, urine output <30ml/hr, soft S1 and S2.
• Risk factors include bicuspid aortic valve, aortitis, rheumatic fever, endocarditis, Marfan’s syndrome and related CTD.

Question 4

Pathophysiology of AR

Answer 4

• LV volume and pressure overload leading to increased wall tension
• To compensate for wall tension, the heart wall undergoes hypertrophy
• Systolic hypertension occurs secondary to increased stroke volume
• Volume overload results in an increase in LV end-diastolic volume

Question 5

Investigation of AR

Answer 5

• ECG
  
  • ST-T wave changes
  • Left axis deviation
  • Conduction abnormalities
• CXR
  
  • Cardiomegaly
• ECHO
  
  • Visualisation of regurgitant jet
• Colour flow doppler
  
  • Detection and quantification of regurgitant flow