valvular heart - aortic regurgitation

Question 1

what is aortic regurgitation?

Answer 1

it’s leaking of the heart’s aortic valve that causes blood to flow in the reverse direction during ventricular diastole, from the aorta back to the left ventricle.

Question 2

what are the diseases of the aorta and leaflets that cause it?

Answer 2

Aorta
- Aortic Root Dilation (50%) (Marfans, hypertension),
- Connective tissue disorders

Leaflets
- Congenital Bicuspid Valve
- Rheumatic heart disease
- Infective Endocarditis
- Myxomatous degeneration (weakening of connective tissue

Question 3

what are the symptoms (including acute and chronic AR)?

Answer 3

Chest Pain
Breathlessness (on exertion, eg. when lying down or at night etc…)
Syncope
Heart Failure
Palpitations

*Acute AR: Poorly tolerated as wall tension cannot acutely adapt

*Chronic AR: Long asymptomatic phase, and Exertional breathlessness

Question 4

what are the 5 signs?

Answer 4

Pulse – large volume and collapsing

Apex Beat - Hyperdynamic, and Displaced

Auscultation: Early Diastolic Murmur (due to blood flowing back to LV). Normal S1 and S2

Wide pulse pressure (large distance between Systolic and Diastolic pressure)

De Musset’s sign (head bobbing)

Quinkes sign (nailbed sensation)

Question 5

what investigations are used?

Answer 5

ECG
Echocardiography
CXR
Cardiac Catheterisation

Question 6

what treatment is given?

Answer 6

Vasodilator therapy
Aortic Valve Replacement or repair