AR

Question 1

AR symptoms

Answer 1

• occurs in late stage of disease -
• exertional dyspnea, fatigue, exertional angina - decreased CO
• palpitations - hyperdynamic ciruclation

Question 2

AR signs

Answer 2

marfanoid features

Ankolysing spondylitis or other seronegative arthropathies

Question 3

AR pulse and BP

Answer 3

• collapsing pulse ‘water hammer’ - most obvious if raising patient’s arm while feeling radial pulse
• wide pulse pressure - DBP very low as leaking back constantly, SBP normal
• bisfiriens pulse - severe AR - venturi effect - rapid ejection and biref in drawing of aortic wall leading to a diminution of the pulse followed by rebound increase

Question 4

AR JVP/neck

Answer 4

prominent carotid pulsations

Question 5

AR palpation

Answer 5

• displaced and dyskinetic apex beat

* diastolic thrill may be felt at LSE if sitting up and exhaling

Question 6

AR auscultation

Answer 6

• T/C - early diastolic, decrescendo quality, high pitched. may extend for variable time into diastole
• loudest at 3/4 ICS
• soft A2 component
• systolic ejection murmur usually also present - aortic stenosis or turbulent flow across normal diameter aortic valve

Question 7

AR accentuation manouvres

Answer 7

• expiration and leaning forward

Question 8

acute AR causes

Answer 8

valvular - IE
aortic root - marfan’s syndrome
dissecting aneurysm of aortic root

Question 9

chronic AR causes

Answer 9

valvular RHD (rarely the only murmur if so)
congenital (bicuspid valve, VSD)
seronegative arthropathy esp ankolysing spondylitis
aoritc root dilation
marfan's
aortitis
rheumatoid arthritis
teritary syphilis
dissecting aneurysm

Question 10

differentiate acute AR to chronic AR

Answer 10

acute - no collapsing pulse (BP is low) and diastolic murmur is short