Medical Archive

C257 Aortic Regurgitation

Etiology

Primary valve disease

Rheumatic disease
- ~2/3 in developing countries
Ankylosing spondylitis
Infective endocarditis

Primary aortic root disease

Bicuspid aortic valve
- M/c cause in developed countries
- Murmur is best heard along the left sternal border at the 3rd and 4th intercostal spaces
Isolated root dilation
- Syphilitic aneurysm
- Aortic dissection
- Murmur commonly radiates toward the right side and is best heard along the right sternal border.

Pathophysiology

LV dilation and eccentric hypertrophy (due to volume overload)

History

Physical findings

?? ? ??? ???, ???.
Head bobbing – de Musset sign
Excertional dyspnea

Arterial pulse

By abrupt distension and collapse of arteries
Stroke volume? ???? Late systole/diastole?? ??? ???? ? ??? ??? ?????
De Musset sign
- Intracranial arteries
- Forceful pulsations with heartbeat.
Corrigan sign
- Peripheral arteries
- Bounding �water-hammer� pulse d/t increased stroke volume.
Duroziez sign
- Femoral arteries
- �Pistol-shot�, “To-and-fro” bruit

Palpation

Auscultation

C234 Physical Examination of the Cardiovascular System
Base
- Lt 3rd ICS(Erb’s area) ?? ??? high pitched diastolic murmur.
- Accentuated when sits up, leans forward, and puts hands behind head ? bringing the aortic valve closer to the stethoscope.
Apex
- SAM?? ??? ??? ?????? fluttering ??? ???? “Austin-Flint murmur” ??
Mid-systolic ejection murmur ??? ?? (??? AS!)

https://www.youtube.com/watch?v=uZysrKXHJMM

Laboratory examination

ECG

Echocardiogram

Chest X-ray

Cardiac catheterization and angiography

Treatment

Acute aortic regurgitation

FIGURE 257-1
Management of patients with aortic regurgitation. See legend for Fig. 256-4 for explanation of treatment recommendations (Class I, IIa, and IIb) and disease stages (B, C1, C2, and D). Preoperative coronary angiography should be performed routinely as determined by age, symptoms, and coronary risk factors. Cardiac catheterization and angiography may also be helpful when there is a discrepancy between clinical and noninvasive findings. Patients who do not meet criteria for intervention should be monitored periodically with clinical and echocardiographic follow-up. AR, aortic regurgitation; AVR, aortic valve replacement (valve repair may be appropriate in selected patients); ERO, ewective regurgitant orifice; LV, lex ventricular; LVEDD, lex ventricular end-diastolic dimension; LVEF, lex ventricular ejection fraction; LVESD, lex ventricular end-systolic dimension; RF, regurgitant fraction; RVol, regurgitant volume.

Chronic aortic regurgitation

Vasodilator? ?? (??? ??? ???) – ACEi, DHP-CCB, hydralazine
Acute AR
??? TOC! (IABP, BB? ??. ? ??? diuretics + vasodilator)
Chronic AR
Diuretics, vasodilator, BP control

Surgical treatment

Indications for AVR
- ?? O: LV function? ???? AVR
- ?? X: LVEF <55%, LVESD >55mm (??? ?? ?? ?? ????), LV diastolic dimension >75mm, LV systolic volume >55mL/m2

FIGURE 257-2
Valve-sparing aortic root reconstruction (David procedure). Aortic root and proximal ascending aorta (A) are resected (B) with sinuses of Valsalva and mobilized coronary artery buttons remaining. Subannular sutures (C) are placed, commissural posts are drawn up inside the valve and the annular sutures are passed through the proximal end of the grax. The annular sutures are tied (D), the valve is re-implanted inside the grax, aortic continuity is re-established with another grax of appropriate size and the coronary buttons are attached to the side of the grax.