Aortic Regurgitation (incompetence)

Notes

Disease

Cardiology | Valvular Heart Disease

Overview

Patients with acute mitral regurgitation (MR) are often gravely ill with significant hemodynamic abnormalities that require urgent medical and usually surgical treatment.
Aortic Reguritation produces a “diastolic murmur”, which is a murmur heart after the second heart sound (S2 – aortic and pulmonary valve closure) when the ventricles are filled with blood.

Aetiology and Risk Factors

Aetiology

Endocarditis
Aortic dissection
Rupture of congenitally fenestrated cusp
Traumatic rupture of valve leaflets
Iatrogenic – complications of aortic balloon valvotomy

Risk Factors

Bicuspid or rarely unicuspid aortic valve
Rheumatic fever
Endocarditis
Marfan’s Syndrome
Aortitis

Clinical Manifestation

Syncope
Dyspnoea
Fatigue
Tachycardia
Orthopnoea
Paroxysmal nocturnal dyspnoea
Signs of pulmonary oedema
Signs and symptoms of cardiogenic shock in chronic aortic regurgitation
- Pallor
- Hypotension
- Diaphoresis
- Cyanosis

Cardiovascular Examination

Signs and cardiogenic shock in chronic regurgitation
Possible signs of aortic stenosis
Carotid collapsing pulse (high amplitude pulse of short durations
Auscultation – Aortic valve (right second intercostal space)
- Soft or absent S1
- S2 is soft, while pulmonary valve has increased sound reflecting pulmonary hypertension
- An S3 is frequently heard but an S4 is absent

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Diagnosis

Differential Diagnosis

Mitral regurgitation
Mitral stenosis
Aortic stenosis
Pulmonary regurgitation

Investigations

ECG – May show non-specific ST and T wave changes, left axis deviation
Chest X-ray
Echocardiogram
Doppler studies

Diagnosis

Echocardiography is diagnostic in acute AR. Echocardiography confirms the presence of AR and identifies its severity and cause. The cause of aortic regurgitation can be determined by identification of characteristic findings such as those of aortic valve endocarditis or aortic dissection.