Aortic Regurgitation

Question 1

What is aortic regurgitation?

Answer 1

Reflux of blood from the aorta into the left ventricle during diastole.

Question 2

6 causes of aortic regurgitation.

Answer 2

Congenital bicuspid valve
Aortic dissection
Infective endocarditis
Rheumatic fever
Connective tissue disorders e.g. Marfan's
Syphilis

Question 3

Epidemiology of aortic regurgitation

Answer 3

75% cases are male

Where the cause is rheumatic fever, it is more common in females

Question 4

4 symptoms of aortic regurgitation

Answer 4

Fatigue
Dyspnoea on exertion
Orthopnoea (ask about pillows)
Angina (not always but may have)

Question 5

5 signs of aortic regurgitation

Answer 5

• Displaced apex beat (inferior and lateral)
• End-diastolic murmur (radiating to left sternal edge)
• Collapsing waterhammer pulse
• Wide pulse pressure
• Quincke’s sign

Question 6

4 investigations for aortic regurgitation

Answer 6

• CXR - dilatation of ascending aorta, cardiomegaly
• ECG - signs of LVH
• Echo - 2D and M-mode to find underlying cause
• Doppler - assesses severity

Question 7

Management of aortic regurgitation

Answer 7

• Vasodilator (nifedipine and ACEi)
• See if this reduces sign of cardiac decompensation
• If symptoms not reduced, or LV ejection fraction <55%, valve replacement

Question 8

2 complications of aortic regurgitation

Answer 8

• LV failure

- Pulmonary oedema