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

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