Aortic regurgitation

Question 1

Define:

Answer 1

Reflux of blood from the aorta to the left ventricle during diastole due to a weakened aortic valve.

a.k.a aortic insufficency

Question 2

Aetiology:

Answer 2

The improper closure of the valve leads to blood flowing back into the left ventricle leading to left ventricular abnormalities such as hypertrophy and enlargement.

Question 3

Risk factors for valve abnormalities or damage:

Answer 3

• bicuspid aortic valve (there is more pressure on the leaflets as this should be a tricuspid valve)
• Infective endocarditis
• rheumatic fever (calcification of the valve may mean that they do not close properly)
• trauma
• age

Question 4

Risk factors for aortic root or ascending aorta dilation:

Answer 4

systemic hypertension

aortic dissection

aortitis

Arthritis (rheumatoid and seronegative)

Connective tissue disorders such as Marfan’s and EH

Oestogenesis imperfecta

Question 5

Epidemiology:

Answer 5

Usually begins in the 50s

Most patients that present are in their 80s

Question 6

Symptoms:

Answer 6

initially will be asymptomatic

Symptoms of heart failure (orthopnea, exertional dysponea and fatigue)

Syncope

palpitations

CCF

Angina

Question 7

Signs:

Answer 7

Collapsing pulse

Wide pulse pressure (there may be 20mmHg between the two arms)

Thrusting and heaving displaced apex beat

Early diastolic murmur which is heard more clearly when sitting forward and exhaling

Mid-diastolic murmur over apex

rare signs - Quincke’s (throbbing in the nail bed) and De Musset’s (nodding in time with the pulse)

Question 8

Investigations:

Answer 8

CXR - cardiomegaly, dilation of the ascending aorta + signs of pulmonary oedema.

ECG

Echo ( may show cause, effects and severity if doppler echo)

cardiac catherisation with angiography

Question 9

what changes would you see on an ECG?

Answer 9

Left ventricular hypertrophy

Deep S in V1/2

Tall R in V5/6

Inverted T waves in lead I, avl and V5/6

LEFT AXIS DEVIATION