Aortic Regurgitation

Pathology:                    

Blood flows back into LV fromaorta leading to high pressure LV, LV dilatation

and increased myocardial oxygen demand

Aetiology:                    

‍Aortic Root: Marfan’s syndrome, dissecting aortic aneurysm,systemic HTN,

aortic rootdilatation, syphilis, connective tissue diseases

Valve: Congenital abnormalities (bicuspid AV, large VSD), connectivetissue     diseases, rheumatic fever,endocarditis.

Acute:Infective endocarditis, Aortic dissection, Acute rheumatic fever, Prostheticvalve failure

Symptoms:                  

Dyspnoea,fatigue, orthopnoea, PND, palpitations

Signs:                              

Chest: heaving, displaced apex beat,diastolic thrill, 3^rd heart sound

Early diastolic, high pitched murmur:best heard at lower left sternal edge

with patient sat forward

Austin-Flintmurmur: Mid-diastolic murmur at apex due to fluttering  

    of mitral valveleaflets with regurgitant flow

Water hammer pulse: Bounding and rapidly collapsing pulse

Wide pulse pressure: High systolic and low diastolic blood pressure

Bisferiens Pulse: Twicebeating in systole; presence of combined AS/AR

de Musset’s Sign: Head bobbing in time with pulse

Corrigan’s Sign: Visiblecarotid pulsations

Quincke’s Sign: Visiblepulsation of nail beds


Traube’s Sign:  Pistol shot diastolic andsystolic sounds heard with the

stethoscope lightlyapplied over the femoral artery

Duroziez’s Test: Lightproximal compression of femoral artery produces a systolic diastolic murmurover femoral artery

Investigations:          

ECG: Left Ventricular Hypertrophy ,LeftAtrial Enlargement, left axis deviation

Chest X-Ray: Left Atrial andVentricular Enlargement, Aortic root dilatation

Echo: Gold standard – assesses for valvular andleaflet abnormalities

Cardiac catheterisation

Coronary angiography: Indicated if age > 40

Treatment:                  

‍Medical: Treat chronic heart failure.

Acute aortic regurgitation may requirestabilisation with vasodilators

Surgical: Aortic valve replacement

Complications:          

Arrhythmias, CHF, prosthetic valvefailure

Prognosis:                  

Once symptomatic poor prognosis

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