Aortic Regurgitation

Question 1

Define AR

Answer 1

Leakage of blood from the aorta into the LV during diastole due to ineffective coaptation of the aortic cusps

Question 2

What are the causes of acute AR?

Answer 2

IE, ascending aortic dissection, chest trauma

Question 3

What are the common causes of chronic AR?

Answer 3

Congenital bicuspid aortic valve, rheumatic fever, connective tissue disorders

Question 4

How does AR cause issues?

Answer 4

Pressure and volume overload. Heart compensates by LV dilation and LVH. Progressive dilation leads to HF

Question 5

What are the key presentations of AR?

Answer 5

Exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea

Question 6

What is orthopnoea?

Answer 6

Dyspnoea lying down

Question 7

What is paroxysmal nocturnal dyspnoea (PNS)?

Answer 7

Dyspnoea in the middle of the night

Question 8

What are the signs of AR?

Answer 8

Displaced and hyperdynamic apex beat, decrescendo early diastolic murmur, Austin flint murmur, wide pulse pressure, collapsing pulse

Question 9

What is the gold standard investigation?

Answer 9

Echocardiogram

Question 10

What other tests could you perform?

Answer 10

ECG, CXR

Question 11

What would an ECG show?

Answer 11

LVH

Question 12

What would a CXR show?

Answer 12

Cardiomegaly, dilated descending aorta, pulmonary oedema

Question 13

What is cardiomegaly?

Answer 13

Abnormal enlargement of the heart

Question 14

What is the definitive treatment?

Answer 14

Surgical replacement

Question 15

What are the indicators for surgery?

Answer 15

Any symptoms, severe AR with enlarged ascending aorta, enlarged LV or deteriorating LV function

Question 16

What medications can be prescribed?

Answer 16

ACEi with the goal to reduce systemic HTN, IE prophylaxis

Question 17

How is AR monitored?

Answer 17

Serial echocardiograms every 6-12 months

Question 18

What are the complications of AR?

Answer 18

Heart failure, infections, arrhythmias, death