Post on 12-Apr-2017
Aortic Regurgitation
Aortic Regurgitation: overviewAR is a condition due to inadequate closure of the
aortic valve leaflets leading to abnormal retrograde flow of blood through the aortic valve during cardiac diastole.
It can be induced either by damage to and dysfunction of the aortic valve leaflets or by distortion or dilatation of the aortic root and ascending aorta
In the developing world, the most common cause of AR is rheumatic heart disease. However, in developed countries, AR is most often due to aortic root dilation or a congenital bicuspid aortic valve .[1]
Causes of Aortic RegurgitationLeaflet abnormalities Aortic root or ascending aortaRheumatic fever Systemic hypertensionEndocarditis Aortitis (eg, syphilis)TraumaBicuspid aortic valve Ankylosing spondylitis
Trauma/ Dissecting aneurysm
Marfan syndrome/ EDSInflammatory bowel disease
AR is seen more commonly in men than in women.
Pathophysiology of aortic regurgitationAortic regurgitation
LV volume
LV mass
LV dysfunction
LV failure
stroke volume
Systolic BP
Diastolic BP
Wide pulse pressure hyperdynamic circulation
Palpitation Initial symptom due to vigrous contraction of
volume overload LVAngina
Less common as C/F ASDyspnoea
Initially on exertionPND
Clinical history
Physical finding Pulse
Very good volume & wide pulse pressureRapid rise & collapse with markedly ed pulse
pressure (water hammer pulse / Corrigan pulse)
Findings are a/w hyperdynamic pulse
deMusset's sign
A head bob occurring with each cardiac cycle
Mueller's sign Systolic pulsations of the uvula.Landolfi sign Change in size of pupil with each beat Quincke's pulses
visible Capillary pulsations in the nailbeds after holding the tip of the nail.
Traube's sign A pistol shot murmur (systolic and diastolic sounds) heard over the femoral arteries.
Duroziez's sign
A systolic and diastolic bruit heard when the femoral artery is partially compressed.to and fro murmur
Hill's sign Normal BP in LL > UL Normal difference is up to 20 In AR the difference > 20
Auscultation Early diastolic murmur
Best heard LSB left 3rd /4th ICS with patient sitting & leaning forward
Lab investigationCXR
CardiomegalyECG
LV hypertrophyEcho
Confirm the diagnosis
TreatmentMedical treatment (for heart failure)
- Diuretics, Digoxin, salt restriction - Vasodilators - Endocarditis prophylaxis
Surgical treatment (in severe cases)AVR
.