FN: Aortic Regurgitation

Question 1

Causes (Acute vs. Chronic)

Answer 1

Acute:

1. Infective endocarditis
2. Type A aortic dissection

Chronic

1. Congenital: bicuspid aortic valve
2. Rheumatic heart disease
3. Connestive tissue: MArfans, Ehler’s Danlos
4. Autoimmune: Ank spond, RA

Question 2

Symptoms

Answer 2

LVF: Exertional dyspnoea, PND, prthopnoea
Arrhythmias (esp. AF) - palpitations: forceful heart beats
Angina

Question 3

signs

Answer 3

Collapsing pulse (Corrignas pulse)
Wide PP
Apex: displaced (volume overload)
HEart sounds: Soft/absent S2 ±s3
Murumur

Question 4

Murmur type

Answer 4

EDM
URSE + 3rd left IC parasternal
Sitting forward in end-expiration
± ejection systolic flow murmur
± Austin-flint murmur

Question 5

Underlying Cause

Answer 5

High -arched palate
Spondyloarthropathy
Embolic phenomena

Question 6

Corrigans sign

Answer 6

Carotid pulsation

Question 7

De Musset’s

Answer 7

head nodding

Question 8

Quinke’s

Answer 8

capillary pulsation in nail beds

Question 9

Traube’s

Answer 9

pistol-shot sound over femorals

Question 10

Austin-Flint murmur

Answer 10

Rumbling MDM @ apex due to regurgitant jet fluttering the ant. mitral valve cusp. = severe AR

Question 11

Duroziezs

Answer 11

systolic murmur over the femoral artery with proximal compression
Diastolic murmur with distal compression

Question 12

Clinical indications of Severe AR

Answer 12

Wide PP and collapsing pulse
S3
Long murmur
Austin flint murmur
Decompensation: LVF

Question 13

Investigation

Answer 13

Blood
ECG
CXR
Echo
Cardiac Catheterisation

Question 14

Blood

Answer 14

FBC
U + E
Lipids
glucose

Question 15

ECG

Answer 15

LVH (R6 + S1 >35 mm)

Question 16

CXR

Answer 16

Cardiomegaly
Dilated ascending aorta
Pulmonary oedema

Question 17

Echo

Answer 17

Aortic valve structure and morphology (e.g. bicuspid)
Evidence of infective endocarditis (e.g. vegetations)
LV functionL ejection fraction, end-systolic dimension

Question 18

Severity in Echo shown by

Answer 18

Jet width (>65% of outflow tract = severe)
Reguritant jet volume
Premature closing of the mitral valve)

Question 19

Cardiac Catheterisation

Answer 19

Coronary artery disease

Assess severty, LV function, root size

Question 20

Management medical

Answer 20

1. Optimise RFs: statins, anti-hypertensives, DM
2. Monitor: regular follow up with echo
3. Reduce systolic hypertension ACEi, CCB (reduce afterload reduce regurg

Question 21

Surgery

Answer 21

Aortic valve replacement
Definitive therapy
Indicated in severe AD if:
1. Symptoms of heart failure
Asymptomatic with LV dysfunction: reduce EF/ increase ES dimensaion