Aortic valve regurgitation

Question 1

Aortic regurgitation: def

Answer 1

• also called aortic insufficiency, blood flows back from the aorta into the left ventricle during diastole

Question 2

Aortic regurgitation: causes

Answer 2

• aortic root dilation: for about half of the cases.
  causes of aortic root dilation -> idiopathic (80%), aortic dissection, aneurysms, syphilis
• infective cause resulting in valvular damage:
  .infective endocarditis,
  .chronic rheumatic fever -> causing fibrosis, and instead of fusing the valves (like in aortic stenosis), they don’t form a nice seal and instead lets blood leak through

Question 3

Aortic regurgitation: consequences

Answer 3

• blood Leaks back from the aorta into the left ventricle during diastole -> left ventricular blood volume increases-> increases the stroke volume -> more blood pumped out of the heart pre squeeze requires more pressure -> so SBP increases
  During diastole -> less blood volume in the aorta -> since some has leaked back into the ventricle -> means DBP decreases
  => result in an increase in pulse pressure (SBP-DBP)
  -> a large pulse pressure is referred to as a hyperdynamic circulation and has its symptoms

Question 4

Aortic regurgitation: symptoms

Answer 4

• due to hyper dynamic circulation:
  .bounding pulses (also called water hammer pulses because the blood, which is most composed of water) slams like a hammer against the wall of the arteries with each heart beat)
  .head bobbing
  .Quincke’s sign; capillary beds in the fingernails to pulsate
• eccentric ventricular hypertrophy
• dyspnea
• orthopnea
• palpitation
• angina
• symptoms underlying cause

Question 5

Aortic regurgitation: D

Answer 5

• physical examination: water hammer pulse, Quincke’s sign

- auscultation: Early diastolic murmur, an early decrescendo diastolic murmur

Question 6

Aortic regurgitation: prognosis

Answer 6

• chronic, around 5years survival in 75% of cases

- acute is more severe with high mortality from LV failure

Question 7

Aortic regurgitation: T

Answer 7

• medical: loop diuretics, vasodilators, ACEi, BB

- surgical: aortic valve replacement