Aortic Regurgitation summary

Question 1

Causes and Pathophysiology of Aortic regurg

Answer 1

Chronic: vol and P overload
Senile: wear and tear, fibrosis/calcification of valve - most common
Bicuspid: congenital, 2/3 cusps are fused (at raphe), wear out faster - commonest in <65
Rheumatic: damage and fusion from rheumatic fever, mitral also damaged
Root dilation: annulus and ascending ao. big.
-Cause: HTN, genetically weak fibrous tissue eg Marfan’s syndrome (Abe Lincoln), Bicuspid AV, syphilis
Acute:
Endocarditis: perforated or vegetation
Flail leaflet: detached somewhat due to endocarditis, trauma

Question 2

Describe clinical syndromes of Aortic regurg

Answer 2

Acute: ↑LVP - ↑LAP - ↑ pulm. P - pulm. edema
Chronic: LVH (eccentric), LV diastolic P only a bit higher. Long asymptomatic period, then gradual onset of symptoms, later LV dysfunction

Question 3

Symptoms of Aortic regurg

Answer 3

PAD
Palpitations: feel beat (due to increased pulse pressure and vol)
Angina: higher demand, but worse perfusion
Dyspnea: late symptom, classic LV decompensation

Question 4

Signs and Physical findings of Aortic regurg

Answer 4

HTN with wide pulse pressure  (bounding pulse)
Carotids pulsing, head bob
Displaced and enlarged apex
Parasternal heave
S3 with LV filling (volume load)
Aortic systolic murmur - diamond shape
Aortic diastolic murmur - blowing decresc. 
Austin-Flint Murmur - hit mitral

Question 5

Key lab tests and findings of Aortic regurg

Answer 5

ECG: maybe see LVH
CXR: LVH, dilated ao. root, maybe calcified valves
Echo (best): see leaflets/root, severity, LVH and fn.
Cardiac catheterization: severity, LV fn and P, assess coronaries

Question 6

Tx of Aortic regurg

Answer 6

Meds: Lower BP (less regurg), Nifedipine (vasodilate and block Ca ch); treat HF symptoms
-avoid lower HR - more regurg
Sx: something…

Question 7

Indications for surgery of Aortic regurg

Answer 7

Serious symptoms or asymptomatic with LV failure