Aortic Regurgitation Flashcards
what is the definition of aortic regurgitation (aortic insufficiency)
reflux of blood from aorta to LV in diastole
what is the aetiology of aortic regurgitation
1. aortic valve abnormalities/damage bicuspid aortic valve infective endocarditis rheumatic fever trauma 2. aortic root dilation systemic HTN aortic dissection aortitis arthritides (joint inflammation) CTD (marfans/ehlers danlos syndrome)
what is the consequence of aortic regurgitation
reflux of blood from aorta into LV in diastole:
LV dilation, increased end-diastolic volume in the heart, increased stroke volume
increased stroke volume and low end-diastolic pressure in aorta may explain collapsing pulse and wide PP
in acute AR, LV cannot adapt to rapid increase in end-diastolic volume
what is the epidemiology of aortic regurgitation
chronic AR begins in 50y/os
most frequently seen in >80s
what is the history of chronic aortic regurgitation
initially asymptomatic
symptoms of HF, exertional dyspnoea, orthopnea, fatigue
angina
what is the history of severe acute aortic regurgitation
sudden cardiovascular collapse
symptoms related to aetiology (aortic dissection-sudden central ‘tearing’ pain)
what are the examination findings in aortic regurgitation
- collapsing pulse
- WPP
- thrusting and heaving displaced apex beat
- early distolic murmur (aortic manoeuvre on expiration)
an ejection systolic murmur might be heard due to increased flow across the valve - austin flint mid-diastolic murmur over apex
flow back into LV hits the anterior cusp of the mitral valve which produces a physiological mitral stenosis
what are the rare examination findings in aortic regurgitation
quinckes sign-visible pulsations in nail bed
de mussets sign-head nodding in time with pulse
mullers sign-visible pulsations of the uvula
what are the investigations in aortic regurgitation
- CXR (cardiomegaly, dilation of ascending aorta, signs of pulmonary oedema)
- ECG
LVH
-deep S wave in V1-2
-tall R wave in V5-6
-inverted T waves in I, aVL, V5-6
-LAD
3 Echo
-2D and M-mode for underlying cause (biscupid aortic valve) and severity of AR
4 doppler for detecting AR and assessing severity
what is the most common cause of AR in developing countries
rheumatic fever
what is the most common cause of AR in developed countries
bicuspid aortic valve
aortic root dilation
what can causes of AR be split into
valvular
non-valvular
what are three valvular causes of AR
1 congenital bicuspid aortic valve
2 infective endocarditis
3 rheumatic fever
what could be a valvular and non-valvular cause of AR
ankylosing spondylitis
what are three causes of non-valvular AR
1 HTN
2 aortic dissection
3 CTDs (marfans pr ehlers danlos)
