aortic regurg

Question 1

define

Answer 1

= reflux of blood from aorta into LV during diastole

Question 2

causes

Answer 2

acute

• IE
• type A aortic dissection
• trauma

chronic

• congenital- bicuspid aortic disease
• damage to aortic valve eg. rheum fever
• aortic root/ descending aorta dilation caused by:
  
  • systemic HTN
  • aortitis [syphilis, takayasu’s arteritis]
  • arthritidies [ra], ank spond
  • conn tiss disease eg. ED/marfans

Question 3

epi

Answer 3

lates 50s

mostly in over 80’s

Question 4

s/s

Answer 4

symptoms:

• LVF- exertional dyspnoea, PND, orthopnoea
• arrhythmia- esp AF
• angina

signs:

• collapsing pulse [corrigans pulse]
• wide pulse pressure
• appex displaced - cos of vol overload
• heart sounds: soft/absent S2, s3
• murmur- early blowing diastolic murmur @ lower left sternal edge, best heard w pt sitting forward breath help on expo
• ejection systolic murmur oft heard cos of increased flow across valve
• austin flint mid diastolic murmur- turbulent reflux hits mitral valve and causes pathological mitral stenosis
• signs of underlying cause
  
  • high arched palate
  • spondyloarthropathy
• eponymous signs
  
  • quincke’s- nail bed pulsatile
  • de musset’s - head nodding w/ pulse
  • becker’s- visible pulsations of pupils/retinal arteries
  • muller’s- pulsatile uvula
  • corrigan’s- pulsatile neck
  • traube’s- ‘pistol shot sound heard in diastolic + systolic upon fem artery auscultation
  • duroriez’s- systolic + diastolic bruit heard upon auscultation of fem arteries
  • rosenbach’s sign- systolic pulsative liver
  • gerhard’s sign- same as above
  • hills sign- pop cuff SBP greater than brachial pressure by >60mmHg.

Question 5

clinical indicators od severe AR

Answer 5

wide PP + collapsing pulse

S3

Long murmur

austin flint [mid diastolic murmur from pathological mitral stenosis]

decompensation- LVF

Question 6

ix

Answer 6

• BLOODS: fbc, u+e, lipids, glucose
• blood pressure:
  
  • a wide pulse pressure, that is a high systolic and low diastolic pressure
• ECG:
  
  • left ventricular hypertrophy
• chest X-ray:
  
  • bilated left ventricle and dilated ascending aorta
• echocardiography and doppler
• cardiac catheterization and angiocardiography

Question 7

mx

Answer 7

Management of acute aortic or mitral regurgitation involves:

• identification of the problem
• medical stabilisation with diuretic and vasodilator (reduce the afterload and thus the regurgitant volume) eg. ACEi/CCB
• urgent valve replacement

Management of chronic disease:

• conservative for mild or moderate disease
• valve surgery - repair, valvotomy or replacement in severe disease
• warfarin anticoagulation for mitral stenosis and mitral regurgitation if there is atrial fibrillation or dilated left atrium - larger than 5 cm on echo
• diuretic if required
• digoxin in atrial fibrillation
• antibiotic prophylaxis to prevent endocarditis
• Note that surgery must be undertaken before the left ventricle dilates to an end systolic dimension of 5.5cm or more. If this has occurred then there is a reduction in prospects for recovery of left ventricular function.

Question 8

complications

Answer 8

L ventricular failure

pulm oedema

Question 9

prognosis

Answer 9

chronic ARwell tolerated for many years w/o symptoms

acute AR= causes by aortic dissection/ IE= fatal if not urgently rx’d.