Aortic regurgitation Flashcards
What causes aortic regurgitation?
Congenital bicuspid valve
Rheumatic heart disease
Connective tissue disorders
Infective endocarditis
What are symptoms of aortic regurgitation?
Murmur
Collapsing Corrigan pulse with wide pressure pulse
Quincke sign
de Musset sign
Palpitations
Dyspnoea
Where can a collapsing Corrigan pulse be palpated?
Peripheral arteries like the radial or brachial artery
What is a collapsing Corrigan pulse?
The arterial wave pulse form has a rapid and forceful upstroke (rapid ejection into aorta) followed by a sudden collapse (as blood returns from aorta in LV due to insufficient aortic valve.
Why is there a wide pulse pressure in aortic regurgitation?
A larger than normal stroke volume of blood is ejected out of the LV into the aorta causing a high systolic blood pressure.
A portion of blood moves back from the aorta into the LV so there is decreased pressure in the aorta during diastole so a lower diastolic pressure.
This results in a wide pulse pressure
(PP = systolic-diastolic pressure)
Describe the murmur in aortic regurgitation?
Early diastolic blowing murmur
Where will an aortic regurgitation murmur be heard best?
At the right sternal border, 2nd intercostal space
What is the name of the murmur that is heard in severe cases of aortic regurgitation?
Austin Flint murmur
Describe an Austin Flint murmur
Mid-diastolic low pitched rumble
Heard when regurgitation so severe that there is a sound as blood bounces off mitral valve cusps
What is the Quincke sign?
Visible pulsation of capillaries in nailbeds with each heartbeat due to wide pulse pressure and accentuated arterial pulsations transmitted to the periphery.
What is the de Musset sign?
Involuntary and rhythmic bobbing of the head with each heartbeat.
Seen in severe aortic regurgitation due to forceful arterial pulsations transmitting to cerebral vasculature.
Best seen when patient is sat or lying and relaxed.
How is aortic regurgitation diagnosed?
ECG
CXR
Gold standard = ECHO to evaluate aortic valve, root and dimensions
How is aortic regurgitation treated?
Consider IE prophylaxis
f symptomatic, surgical valve replacement
