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    Aortic Regurgitation

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    Fahd Hatem
    The document discusses aortic regurgitation including its etiology, symptoms, physical exam findings, methods for assessing severity, natural history, and guidelines for surgical treatment timing. Causes of aortic regurgitation include congenital defects, connective tissue disorders, infections, and hypertension. Symptoms include dyspnea, orthopnea, and chest pain. The physical exam looks for widened pulse pressure, diastolic murmurs, and signs of left ventricular enlargement and dysfunction. Surgery is recommended before the development of left ventricular dysfunction or symptoms for some patients.

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    © All Rights Reserved
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    Aortic Regurgitation

    Uploaded by

    Fahd Hatem
    157 views14 pages
    The document discusses aortic regurgitation including its etiology, symptoms, physical exam findings, methods for assessing severity, natural history, and guidelines for surgical treatment timing. Causes of aortic regurgitation include congenital defects, connective tissue disorders, infections, and hypertension. Symptoms include dyspnea, orthopnea, and chest pain. The physical exam looks for widened pulse pressure, diastolic murmurs, and signs of left ventricular enlargement and dysfunction. Surgery is recommended before the development of left ventricular dysfunction or symptoms for some patients.

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    The document discusses aortic regurgitation including its etiology, symptoms, physical exam findings, methods for assessing severity, natural history, and guidelines for surgical treatment timing. Causes of aortic regurgitation include congenital defects, connective tissue disorders, infections, and hypertension. Symptoms include dyspnea, orthopnea, and chest pain. The physical exam looks for widened pulse pressure, diastolic murmurs, and signs of left ventricular enlargement and dysfunction. Surgery is recommended before the development of left ventricular dysfunction or symptoms for some patients.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    157 views14 pages

    Aortic Regurgitation

    Uploaded by

    Fahd Hatem
    The document discusses aortic regurgitation including its etiology, symptoms, physical exam findings, methods for assessing severity, natural history, and guidelines for surgical treatment timing. Causes of aortic regurgitation include congenital defects, connective tissue disorders, infections, and hypertension. Symptoms include dyspnea, orthopnea, and chest pain. The physical exam looks for widened pulse pressure, diastolic murmurs, and signs of left ventricular enlargement and dysfunction. Surgery is recommended before the development of left ventricular dysfunction or symptoms for some patients.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 14

    Valvular Heart Disease

    Aortic Regurgitation

    Continuing Medical Implementation

    Aortic Regurgitation

    Etiology
    Physical Examination
    Assessing Severity
    Natural History
    Prognosis
    Timing of Surgery

    Continuing Medical Implementation

    Aortic Regurgitation:
    Etiology
    Any conditions resulting in
    incompetent aortic leaflets
    Congenital
    Bicuspid valve

    Aortopathy
    Cystic medial necrosis
    Collagen disorders (e.g.
    Marfans)
    Ehler-Danlos
    Osteogenesis imperfecta
    Pseudoxanthoma elasticum

    Acquired
    Rheumatic heart disease
    Dilated aorta (e.g.
    hypertension..)
    Degenerative
    Connective tissue disorders
    E.g. ankylosing spondylitis,
    rheumatoid arthritis, Reiters
    syndrome, Giant-cell arteritis )

    Syphilis (chronic aortitis)

    Acute AI: aortic dissection,


    infective endocarditis,
    trauma

    Continuing Medical Implementation

    Aortic Regurgitation:
    Symptoms
    Dyspnea, orthopnea, PND
    Chest pain.
    Nocturnal angina >> exertional angina
    ( diastolic aortic pressure and increased LVEDP thus
    coronary artery diastolic flow)

    With extreme reductions in diastolic pressures


    (e.g. < 40) may see angina

    Continuing Medical Implementation

    Peripheral Signs of Severe


    Aortic Regurgitation
    Quinckes sign: capillary
    pulsation
    Corrigans sign: water
    hammer pulse
    Bisferiens pulse (AS/AR >
    AR)
    De Mussets sign: systolic
    head bobbing
    Muellers sign: systolic
    pulsation of uvula

    Durosiers sign: femoral


    retrograde bruits
    Traubes sign: pistol shot
    femorals
    Hills sign:BP Lower
    extremity >BP Upper
    extremity by
    > 20 mm Hg - mild AR
    > 40 mm Hg mod AR
    > 60 mm Hg severe AR

    Continuing Medical Implementation

    Wave Sound

    Aortic Regurgitation:
    Physical Exam
    Widened pulse pressure

    Systolic diastolic =
    pulse pressure

    High pitched, blowing,


    decrescendo diastolic
    murmur at LSB
    Best heard at endexpiration & leaning
    forward
    Hands & Knee position

    S1

    Continuing Medical Implementation

    S2

    S1
    Wave Sound

    Central Signs of Severe


    Aortic Regurgitation
    Apex:

    Enlarged
    Displaced
    Hyper-dynamic
    Palpable S3
    Austin-Flint
    murmur

    Aortic diastolic
    murmur
    length correlates with
    severity (chronic AR)
    in acute AR murmur
    shortens as
    Aortic DP=LVEDP
    in acute AR - mitral
    pre-closure

    Continuing Medical Implementation

    Assessing Severity
    of AR
    Assess severity by impact on peripheral
    signs and LV

    peripheral signs = severity


    LV = severity
    S3
    Austin -Flint
    LVH
    radiological cardiomegaly

    Continuing Medical Implementation

    Aortic Regurgitation:
    Natural History
    Asymptomatic
    %/Y
    Normal LV function (~good prognosis)

    Progression to symptoms or LV dysfunction


    Progression to asymptomatic LV dysfunction
    75% 5-year survival
    Sudden death
    < 0.2

    <6
    < 3.5

    Abnormal LV function
    Progression to cardiac symptoms

    25

    Symptomatic (Poor prognosis)


    Mortality

    > 10

    TX: Medical Surgery BEFORE LV dysfunction


    Continuing Medical Implementation

    Bonow RO, et al, JACC. 1998;32:1486.

    Echo Indications for Valve Replacement


    in Asymptomatic AR & MR

    Type of
    LVESD mm
    Regurgitation

    EF

    FS
    %

    Aortic

    > 55

    < 55

    <0.27

    Mitral

    > 45

    < 60

    < 0.32

    Continuing Medical Implementation

    Indication for Valve Replacement in


    Aortic Regurgitation
    ACC/AHA Class I
    Symptomatic patients with preserved LVF (LVEF
    >50%)
    Asymptomatic patients with mild to moderate LV
    dysfunction (EF 25-49%)
    Patients undergoing CABG, aortic or other valvular
    surgery

    ACC/AHA Class II a
    Asymptomatic patients with preserved LVEF but severe
    LV dilatation (EDD>75 mm or ESD > 55mm)
    Continuing Medical Implementation

    Indication for Valve Replacement in


    Aortic Regurgitation
    ACC/AHA Class II b
    Patients with severe LV dysfunction (EF < 25%)
    Asymptomatic patients with normal systolic func-tion at
    rest (EF >0.50) and progressi ve LV dilata-tion when the
    degree of dilatation is moderatelysevere (EDD 70 to 75
    mm, ESD 50 to 55 mm).

    ACC/AHA Class III


    Asymptomatic patients with normal systolicf
    unction at rest (EF >0.50) and LV dilatation
    when the degree of dilatation is not severe
    (EDD <70 mm, ESD <50 mm).

    Continuing Medical Implementation

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