Aortic Regurgitation

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Aortic regurgitation

    • Etiology
      • Aortic root dilatation: (MCQ)
        • Idiopathic (correlates with hypertension [HTN] and age),
        • collagen vascular disease
        • Marfan’s syndrome
      • Valvular disease: Rheumatic heart disease, endocarditis
      • Proximal aortic root dissection:
        • Cystic medial necrosis (Marfan’ssyn- drome),
        • syphilis, HTN
        • Ehlers–Danlos,
        • Turner’s syndrome
        • 3rd trimester pregnancy(MCQ)
    • Signs and symptoms
        • Dyspnea, orthopnea, paroxysmal nocturnal dyspnea
        • Angina(MCQ)
          • due to reduced diastolic coronary blood flow due to low pressure in aortic root
        • Left ventricular failure
        • Wide pulse pressure
        • Bounding “Corrigan” pulse(MCQ)
        • “pistol shot”femorals(MCQ)
        • pulsusbisferiens (dicrotic pulse with two palpable waves in systole)(MCQ)
        • Duroziez sign: (MCQ)
          • Presence of diastolic femoral bruit when femoral artery iscompressed enough to hear a systolic bruit
        • Hill’s sign: (MCQ)
          • Systolic pressure in the legs > 20 mm Hg higher than in thearms
        • Quincke’s sign: (MCQ)
          • Alternating blushing and blanching of the fingernailswhen gentle pressure is applied
        • De Musset’s sign: (MCQ)
        • Bobbing of head with heartbeat
      • Diagnosis/signs
        • High-pitched, blowing, decrescendo diastolic murmur
          • best heard over 2nd right interspace or 3rd left interspace(MCQ)
          • accentuated by leaning forward(MCQ)
        • Austin Flint murmur:(MCQ)
          • Observed in severe regurgitation(MCQ)
          • low-pitched diastolic rumble due to regurgitated blood striking the anterior mitral leaflet (similar sound to mitral regurgitation)(MCQ)
        • Hyperdynamic down and laterally displaced PMI due to LV enlargement
        • ECG shows left ventricular hypertrophy(MCQ)
        • Echocardiography demonstrates regurgitant valve.
      • Treatment
        • Treat left ventricular failure.
        • Endocarditis prophylaxis
        • Valve replacement(MCQ)
          • necessary for severe cases
          • the only definitive treatment.
      • Clinical Pearls for MD Entrance :
        • Conditions with wide pulse pressure:(MCQ)
          • Aorticregurgitation
          • Hyperthyroidism
          • Anemia
          • Wetberiberi
          • Hypertrophicsubaorticstenosis
          • Hypertension
        • Acute valvular disorders (e.g., acute MR or AR)
          • result in severe decompensation into CHF due to the absence of hemodynamic compensation.
        • The Murmurs
        • Mitral stenosis––(MCQ)
          • diastolic rumble with opening snap
        • Mitral regurgitation (chronic)(MCQ)
          • holosystolic blowing murmur radiating to axilla
        • Mitral valve prolapse(MCQ)
          • mid-systolic click
        • Hypertrophic cardiomyopathy (HCM)(MCQ)
          • systolic, brisk upstroke, parasternal lift
        • Patent ductusarteriosus (PDA)(MCQ)
          • continuous, machinery murmur
        • Atrial septal defect (ASD)(MCQ)
          • fixed, split S2
        • Ventricular septal defect (VSD)(MCQ)
          • systolic, radiates to right
        • Aortic regurgitation(MCQ)
          • water- hammer pulse, decrescendo mid-diastolic
        • Aortic stenosis(MCQ)
          • harsh, systolic murmur that radiates to carotids, “parvus et tardus”
        • A rumbling diastolic murmur can be due to mitral stenosis (MS) or tricuspid stenosis (TS).
          • TS will increase with inspiration.
          • Emergent surgery is required.
      • Aortic regurgitation (CHRONIC REGURGITATION)
          • Usually asymptomatic until middle age
          • presents with left-sided failure or chest pain.
          • Wide pulse pressure.
          • Hyperactive, enlarged LV.
          • Diastolic murmur along left sternal border.
          • ECG shows LVH; radiograph shows LV dilation.
          • Echocardiography/Doppler is diagnostic.
          • Afterload reduction may be beneficial if (MCQ)
            • theLV is dilated (LV end-diastolic dimension > 5.0 cm)
            • there is evidence for systolic blood pressure elevation.
          • Surgery indicated
            • for symptoms, (MCQ)
            • EF < 55%,
            • LV end-systolic dimension > 5.0 cm


      Aortic Regurgitation – Sound
      This is the heart sound heard in the case of aortic regurtitation. I have kept various types heard in different people. Don’t Remember the sound but it’s pattern for better understanding.
      What is aortic regurgitation?
      ortic regurgitation is a problem the aortic valve can develop. A patient with aortic regurgitation can be difficult to evaluate because the patient can be symptomatic for a long period of time. The concern is that the left ventricle develops an overload from all of the blood rushing back into the ventricle, which causes it to become dilated. Anytime a patient develops a decrease in the function of their heart, with left ventricular dilation, doctors are quick to recommend an aortic valve replacement. For more information about heart surgery at Swedish
      aortic regurgitation
      Animated Aortic Regurgitation Murmur
      Aortic Insufficiency / Regurgitation Murmur
      Aortic regurgitation
      Early diastolic murmur
      Physical Diagnosis: Aortic Regurgitation
      Lecture on the physical diagnosis of aortic regurgitation.
      Aortic Regurgitation
      Harvard Medical School video about aortic regurgitation