aortic valve regurgitation

Question 1

etiology - acquired. congenital

Answer 1

rheumatic fever and infective endocarditis. congenitally abnormal valve (e.g. a bicuspid valve).
1. Acquired—trauma, aortic dilatation (Marfan‘s syndrome, syphilis, aneurysm), infective endocarditis, rheumatic disease
2. Congenital–bicuspid valve or disproportionate cusps

Question 2

Pathophysiology

Answer 2

Disease of aortic valve cusps (congenital bicuspid valve, rheumatic heart disease, infective endocarditis) or dilatation of aortic
root

Left ventricle dilates & hypertrophies to compensate for regurgitation

Stroke of left ventricle doubled or trebled & major arteries pulsate

Progress disease - left ventricular diastolic pressure rises (breathlessness at first only with exercise)

Question 3

hemodynamic abnormalities

Answer 3

reflux of blood from the aorta thorugh aortic valve in to the left ventricle during diastole and blood is also delivered in to left ventricle from atrium at the same time, this lead to overfills and distend the left ventricle during diastole.
during systole left ventricle has to contract with greater force to expell large amount of blood into the aorta.
intensified work of left ventricle cause its hypertrophy and increase systolic volume in aorta cause dilation.
There is a marked variation of BP in aorta during systole & diastole.
Increased blood vol in aorta at systole ↑es systolic P & part of blood returned to vent at diastole causes diastolic P to↓.

Question 4

clinical picture - sign and symptoms

Answer 4

symptoms
- symptoms occur late. ‗pounding of the heart‘ because increased left ventricular size and its vigorous pulsation. Angina pectoris is a complaint.
- Paroxysmal nocturnal dyspnoe, Tachycardia, dyspnea, weakness, Giddiness-deranged b/supply to brain
- Pallid skin, Aortic face

Signs
- The pulse is bounding or collapsing. hyperdynamic circulation:
1. Quincke‘s sign – capillary pulsation in the nail beds

2. De Musset‘s sign – head nodding with each heart beat
3. Duroziez,s sign –murmur on femoral artery is auscultated with pressure applied
4. pistol shot femorals –sharp bang on auscultation over the femoral arteries with each heart beat.

• high-pitched early diastolic murmur at the left sternal in expiration. ejection systolic flow murmur.

Question 5

investigation

Answer 5

1. Palpation- shifting apex beat to the left & inferiorly
2. Percussion- cardiac dulless- shifted to left
3. Auscultatn- Soft both heart sounds.
   - diastolic murmur at Botkin Erb point (in deep breathing)
   - Austin Flint murmur- soft mid-diastolic murmur present
   - 3rd & 4th sound may appear.
   - Traube double sound heard over femoral aa
4. Pulse- fast , full & ↑.
5. Chest X-ray–left ventricular enlargement and dilatation of the ascending aorta.
6. ECG–left ventricular hypertrophy– tall R waves and deeply inverted T waves in left-sided chest leads, and deep S waves in the right-sided leads. Normally, sinus rhythm is present.
7. Echocardiogram- vigorous cardiac contraction and a dilated left ventricle. aortic root enlarged. Diastolic fluttering of the mitral leaflets or septum (Austin Flint murmur).
8. Cardiac catheterization–injection contrast into the aorta outline aortic valvular abnormalities and assess degree of regurgitation.