AORTIC REGURGITATION

CAUSES of AORTIC REGURGITATION

1. Congenital - bicuspid valve, or disaproportionate cusps

2. Acquired - rheumatic disease, infective endocarditis, trauma, aortic dilatation (Marfan syndrome, atheroma, syphilis, ankylosis spondylitis)

Pathophysiology:

• the stroke volume is increased, as the LV ejects both the forward output and the blood that regurgitates during diastole (hypertrophy end dilatation of the left ventricle) - marked regurgitation

• pulsative arteries

• increased left ventricular diastolic pressure

• increased pulmonary vascular pressure (breathlessness)

SYMPTOMS of AORTIC REGURGITATION

1. Mild to moderate AR - often asymptomatic, awareness of heart failure, palpitations

2. Severe AR - symptoms of heart failure, angina (reduced diastolic coronary perfusion gradient)

SIGNS of AR

1. Pulses - large volume and collapsing pulse, bounding peripheral pulses, capillary pulsation in nail-beds (Quincke's sign), femoral bruit (pistol shot - Durozier's sign), heart nodding with pulse (de Musset's sign)

2. Murmurs - early diastolic murmur, systolic murmur of increased stroke volume, Austin Flint murmur at the apex (soft mid-diastolic that reflects relative mitral stenosis related to increased ventricular diastolic pressure on the mitral valve)

3. Other signs - thrusting apex, 4th heart sound, enlarged LV, signs of heart failure

INVESTIGATIONS

1. ECG - marked regurgitation-left ventricular hypertrophy and ST changes

2. CXR - cardiac and aortic dilatation; features of left ventricular failure

3. ECHO - dilated ventricle with vigorous contraction (until heart failure ensures); fluttering anterior mitral leaflet in the regurgitant jet vegetations in infective endocarditis;

4. Cardiac catheterisation - may not be required
   

Category: Cardiology Notes