Condition- Aortic Regurgitation

Question 1

What is aortic regurgitation?

Answer 1

Reflux of the blood from the aorta into the left ventricle during diastole due to a weakened aortic valve aka aortic insufficiency

Question 2

What are the two groups of causes for aortic regurgitation

Answer 2

1. Aortic valve leaflet damage => valve doesn’t close tightly -> backflow
2. Aortic root/ ascending aorta dilation

Question 3

List some causes of aortic valve leaflet damage

Answer 3

• Bicuspid aortic valve
• Infective endocarditis
• Rheumatic fever
• Trauma
• Age

Question 4

List some acuses of aortic root dilation

Answer 4

• Systemic hypertension
• Aortic dissection
• Aortitis
• Arthritides (rheumatoid/ seronegative)
• Connective tissue disease (Marfan’s, Ehler’s Danlos)
• Pseudoxanthoma elasticum. Osteogenesis imperfecta

Question 5

What pathological change occurs to the heart following prolonged aortic regurgitation?

Answer 5

You get left ventricular enlargement and hypertrophy to maintain a normal CO

Question 6

List some of the presenting symptoms of chronic AR

Answer 6

• Asymptomatic initially
• Later on may develop symtpoms of HF
  
  • Exertional dyspnoea
  • orthopnoea
  • Fatigue
• Also: palpitations, angina, syncope and CCF

Question 7

List some of the presenting symptoms of acute AR

Answer 7

• Sudden cardiovascular collapse (LV cannot suddenly adapt to rapid increase in end-diastolic volume)

Question 8

Which murmur is heard in aortic regurgitation? (+ which accentuation murmur)

Answer 8

early diastolic murmur heard best over aortic area (right sternal angle with patient sitting foward with breath held at top of expiration)

Question 9

List some signs seen on examination of a patient with Aortic regurgitation

Answer 9

• Collapsing (water-hammer pulse)
• Wide pulse pressure
• thrusting and heaving displaced apex beat
• Soft or absent A2 due to inadequate aortic valve closure
• aortic early diastolic murmur
• Signs of cardiogenic shock
  
  • rapid + faint peripheral pulse
  • mottles extremities
  • pallor
• Signs of HF
  
  • JVP distension
  • basal lung creps
  • tachyopnoea

Question 10

Describe the character of the pulse felt in a patient with aortic regurgitation

Answer 10

Collapsing (Water hammer or Corrigan’s) pulse= rapid rise + quick collapse

Question 11

List three potential murmurs that might be heard in patients with Aortic regurgitaiton and why are they heard

Answer 11

1. Early diastolic murmur= reflux of blood through aortic valve on diastole
2. ESM= increased flow across valve due to increased stroke volume
3. Austin-Flint murmur= mid-late diastolic murmur heard at the apex caused by jet of blood of aortic regurgitant hitting left ventriclular endocardium
   
   • Different to murmur of mitral stenosis due to absence of opening snap + loud S1

Question 12

Which investigation is the preferred method of diagnosing the cause and severity of AR

Answer 12

Echocardiogram

Question 13

List some investigations you could conduct on a patient with aortic regurgitation

Answer 13

• ECG: LVH signs
• CXR: cardiomegaly, dilation of aorta, pulmonary oedema
• Echocardiogram: shows undeerlying cause, shows effects of AR + indicates severity + monitor progression
• Doppler- US: indicates amount of regugitant flow

Question 14

List some specific signs of AR

Answer 14

• de Musset’s sign= head bobbing in time with heart beat
• Muller’s sign= pulsation of uvula
• Quinke’s sign= nailbed pulsation
• Corrgian’s sign= visible pulsations in the neck