Valves - Aortic Regurgitation

Question 1

What is AR?

Answer 1

Leaking of blood from AV back into the LV during ventricular diastole

Question 2

Causes of AR?

Answer 2

Aorta - dilated aorta

Leaflets -

Bicuspid leaflet instead of tricuspid
Rheumatic heart disease,
IE
Myxomatous degeneration

Question 3

Causes of a dilated aorta?

Answer 3

Marfans
Hypertension
CT disorders

Question 4

What effect can AR have on the LV?

Answer 4

The LV starts to enlarge to maintain net cardiac output

This causes an increased cardiac demand for O2 leading to cardiac ischaemia and LV failure

Question 5

What else does the aortic runoff effect?

Answer 5

Since its during diastole - causes diastolic BP to fall and coronary perfusion decreases

Question 6

Is acute AR easy to spot?

Answer 6

Acute AR is poorly tolerated as wall tension can’t adapt quickly - so yes

Question 7

Symptoms of chronic AR?

Answer 7

Has a long asymptomatic phase - eventually

Angina
Dyspnoea

Question 8

What is found on examination?

Answer 8

Collapsing pulse
Displaced apex beat
LV heave
LV failure

Question 9

What is heard on auscultation?

Answer 9

High pitched early diastolic murmur - should be soft

Question 10

What investigations can be done?

Answer 10

ECG
Echocardiograph
CxR

Question 11

What is looked for in a CxR?

Answer 11

Cardiomegaly - enlarged heart in chronic AR

Question 12

What is looked for in an echo?

Answer 12

AV cusp anatomy

LVH

Doppler haemodynamic function assessment of the regurgitated flow

Question 13

What is looked for in an ECG?

Answer 13

ST/T changes to detect LV strain

Question 14

When would/can cardiac catheterisation be used?

Answer 14

To assess heart vessels for CAD before surgery

Question 15

Treatment?

Answer 15

Vasodilators can be used to extend time until surgery is needed

Surgery - valve repar/replacement