12.30.2011

AORTIC REGURGITATION

Posted on 11:59 PM by know about heart


During the time of diastole, there is leakage of blood from aorta to left ventricle .In aortic regurgitation the aortic valve fails to close completely leading to reserved blood flow.
TYPES:
1. Acute AR (aortic regurgitation)
2. Chronic AR (aortic regurgitation)

Symptom & signs of aortic regurgitation:
Symptoms:
i)                   Mild to moderate AR:
§ Often asymptomatic,
§ Awareness of heart beat, palpitations.
ii)                Severe AR:
§ Breathlessness,
§Angina.
Signs:
i)                   Pulses:
§Large volume or collapsing pulse,
§ Low diastolic and increased pulses pressure,
§ Bounding peripheral pulses,
§ Capillary pulsation in nail beds-Quincke’s sign,
§ Femoral bruit (Pistol shot) Durozie’s sign
§ Head nodding with pulse-de Musset’s sign.
ii)                Murmurs:
§ Early diastolic murmur (best heard with the diaphragm in left 3rd/4th intercostals space with the patient leaning forward and breath hold in expiration.)
               § Systolic murmur (increased stroke volume)
               § Astin Flint murmur (soft mid diastolic)
iii)              Other signs:
 § Displaced, rocking apex beat (volume over load)
§ Pre-systolic impulse
§ 4th heart sound
§ Pulmonary venous congestion (crepitations)
§Rheumatic fever
§Bicuspid valve disease
§Systemic hypertension
§Syphilis
                  §Marfan’s syndrome
                 §Aortic dissection

EFFECT:
Left ventricular dilation and hypertrophy which may lead to left sided heart failure followed by right sided heart failure.
Investigations:
i)                   ECG:
§ Initially normal, later 1v hypertrophy and T-wave inversion
§LVH (left ventricular hypertrophy)
§Left atrial enlargement

ii)                Chest x-ray:
§ Cardiac dilatation, may be aortic dilatation
§ Features of left heart failure

iii)              Echo:
§ Dilated left ventricle
§ Hyperdynamic left ventricle
§ Fluttering anterior mitral (may not be required). \
§ Dilated LV
§ Aortic regurgitation
§ Dilated aortic root
Management:
i)                   Asymptomatic patients should also be followed up annually with echocardiography.
ii)                Rx according to underlying condition such as endocarditis or syphilis,
iii)              Aortic valve replacement is indicated if aortic regurgitation causes symptoms, and this may need to be combined with aortic root replacement and coronary bypass surgery.
iv)  Systolic blood pressure should be controlled with vasodilating drugs such as nifedipine or ACE inhibitors. .Medical support by vasodialator and diuretics.

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