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Aortic Regurgitation (AR)

Etiology

  • Congenital – bicuspid AV
  • Acquired
  • Acute causes – endocarditis, dissecting aorta rheumatic fever
  • Chronic causes – rheumatic heart disease, bicuspid AV, syphilis, osteogensis imperfecta, marfan, SLE, arteritis

Pathogenesis

  • AR is the reflux of blood from the aorta into the LV during diastole
  • LV dilates and hypertrophies to compensate for the regurgitation and to maintain CO
  • The SV of the LV can eventually be doubled
    • Major arteries become visibly pulsatile
  • Because of the decreased blood in the aorta during diastole, diastolic BP falls – coronary perfusion decreases
  • As disease progresses, LVDP increases and breathlessness develops

Clinical features

  • Significant symptoms occur late. The early symptoms are
    • Palpitations, breathlessness
  • Angina
  • Collapsing pulse
  • ↑pulse pressure
  • Austin Flint murmur – soft, low pitched, rumbling mid-diastolic (indicates severe AR)

Signs – indicate hyperdynamic circulation

  • Quincke’s sign – capillary pulsation in nail beds
  • de Musset’s sign – head nodding with each heart beat
  • Duroziez’s sign (severe AR) – murmur heard when femoral artery auscultated
  • Pistol shot femorals – sharp bang heard with each heart beat upon auscultation of femoral artery

Investigations

Treatment

  • Treat underlying conditions e.g. endocarditis
  • Follow up asymptomatic patients with yearly ECHO for evidence of increasing ventricular size
  • Control SBP – CCB (nifedipine)/ACEi
  • Aortic valve replacement (±CABG/aortic root replacement) – if patient is symptomatic
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