Valve diseases - Aortic Regurgitation Flashcards
Regurgitation definition
Causes INSUFFICIENCY + proximal chanber DILATION (Regurg = defective valve, FLOPPY)
= Loss of structural chamber integrity + strength
Aortic regurg definition
Leaky aortic valve, insufficient
Epidemiology
Men
Prevalence increases with age
Risk factors
SLE
Marfans + Ehlers-Danlos syndrome - connective tissue dissorders
Aortic dilation
Infective Endocarditis
Aetiology Acute
Infective Endocarditis
Ascending aortic dissection
Chest trauma
Aetiology Chronic
Congenital
Connective tissue disorders (Ehlers-Danlos Syndrome)
Rheumatic fever
Rheumatoid arthritis
SLE
Pathophysiology
Aortic regurgitation = reflux of blood from the aorta through aortic valve into left ventricle during diastole.
If net cardiac output is to be maintained the total volume of blood pumped into the aorta must increase + consequently the left ventricular size must enlarge resulting in left ventricular dilation + hypertrophy = heart failure
Also, due to the fact that the remaining blood in the root of the aorta supplies the coronary arteries via coronary sinus during diastole - regurgitation causes diastolic blood pressure to fall + thus coronary perfusion decreases.
Signs
EARLY DIASTOLIC BLOWING MURMUR at right sternal border 2nd intercostal space
- collapsing (water hammer) Corrigan pulse with wide pulse pressure
- Austin flint murmur (severe) - mid diastolic low-pitched rumble = when regurgitation so severe blood bounces of mitral valve cusps + makes sound
- Quincke’s Pulse = severe = nail bed pulses when pressed and De Musset (head throbbing) signs
Symptoms
Exertional dyspnoea
Orthopnoea
Proximal nocturnal dyspnoea
Palpitations
Angina
Syncope
Diagnosis
ECG -LVH
CXR - Cardiomegaly, dilated ascending aorta, pulmonary oedema
GOLD STANDARD = ECHO - Aortic valve root + dimentions
Management
Medical therapy - ACE-I - Ramipril
Surgical valve replacement therapy
