Aortic Regurgitation

Darrell Sneed, MD FACCStern Cardiovascular Foundation

Disclosure

• Unfortunately none

Aortic Regurgitation• Causes

• Biscuspid AV• Infective endocarditis• Senile degenerative disease• Collagen vascular disease• VSD• Subaortic stenosis• Aortic root dilatation• Aortic dissection

• Must know if etiology is valvular or aortic disease

• Often associated with MV abnormality also

Pathophysiology• Acute

• Abrupt increase in LVEDP with noncompliant LV and high EF and nL LV size

• Dyspnea &/or pulmonary edema

• Chronic• Excess volume stretches & elongates

myocardial fibers which increases wall stress and causes hypertrophy

• During exercise the volume of AI decreased b/c increased HR causes shortened diastolic period and decreased SVR

Clinical Syndrome• Dyspnea• Widened pulse pressure >100mmHg with DBP

<60mmHg• Uncomfortable awareness of heart & neck vessels• Diastolic thrill at the base of the heart• High pitch diastolic, decresendo murmur best @ LSB• de Musset sign• Quincke sign• Marfan characteristics• IE stigmata• Corrigan pulse• Duroziez murmur• Austin Flint murmur

Evaluation

• ECG not necessarily unless LVH with chronic AI

• CXR can hide may hide the proximal portion in the cardiac silhouette

• TTE• TEE • MRI• Aortography

Acute AI Treatment

• Surgery!

Dr. Brad Wolf- cardiothoracic surgery

Chronic AI Treatment• Long standing overload causes

progressive fibrosis and myocyte degeneration with subsequent LV dysfunction

• Regular follow-up with echo q6- 12 months

• Dental hygiene and IE prophylaxis• LV dysfunction usually develops

before symptoms• Surgery

References• Mayo Clinic Cardiology Third Edition• J Am Coll Cardiol. 2013;61(7):693-701• J Am Coll Cardiol. 1998;32(5):1486-1582

Thank you!