FN: Aortic Regurgitation Flashcards Preview

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Flashcards in FN: Aortic Regurgitation Deck (21):
1

Causes (Acute vs. Chronic)

Acute:
1. Infective endocarditis
2. Type A aortic dissection

Chronic
1. Congenital: bicuspid aortic valve
2. Rheumatic heart disease
3. Connestive tissue: MArfans, Ehler's Danlos
4. Autoimmune: Ank spond, RA

2

Symptoms

LVF: Exertional dyspnoea, PND, prthopnoea
Arrhythmias (esp. AF) - palpitations: forceful heart beats
Angina

3

signs

Collapsing pulse (Corrignas pulse)
Wide PP
Apex: displaced (volume overload)
HEart sounds: Soft/absent S2 ±s3
Murumur

4

Murmur type

EDM
URSE + 3rd left IC parasternal
Sitting forward in end-expiration
± ejection systolic flow murmur
± Austin-flint murmur

5

Underlying Cause

High -arched palate
Spondyloarthropathy
Embolic phenomena

6

Corrigans sign

Carotid pulsation

7

De Musset's

head nodding

8

Quinke's

capillary pulsation in nail beds

9

Traube's

pistol-shot sound over femorals

10

Austin-Flint murmur

Rumbling MDM @ apex due to regurgitant jet fluttering the ant. mitral valve cusp. = severe AR

11

Duroziezs

systolic murmur over the femoral artery with proximal compression
Diastolic murmur with distal compression

12

Clinical indications of Severe AR

Wide PP and collapsing pulse
S3
Long murmur
Austin flint murmur
Decompensation: LVF

13

Investigation

Blood
ECG
CXR
Echo
Cardiac Catheterisation

14

Blood

FBC
U + E
Lipids
glucose

15

ECG

LVH (R6 + S1 >35 mm)

16

CXR

Cardiomegaly
Dilated ascending aorta
Pulmonary oedema

17

Echo

Aortic valve structure and morphology (e.g. bicuspid)
Evidence of infective endocarditis (e.g. vegetations)
LV functionL ejection fraction, end-systolic dimension

18

Severity in Echo shown by

Jet width (>65% of outflow tract = severe)
Reguritant jet volume
Premature closing of the mitral valve)

19

Cardiac Catheterisation

Coronary artery disease
Assess severty, LV function, root size

20

Management medical

1. Optimise RFs: statins, anti-hypertensives, DM
2. Monitor: regular follow up with echo
3. Reduce systolic hypertension ACEi, CCB (reduce afterload reduce regurg

21

Surgery

Aortic valve replacement
Definitive therapy
Indicated in severe AD if:
1. Symptoms of heart failure
Asymptomatic with LV dysfunction: reduce EF/ increase ES dimensaion

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