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Aortic Regurgitation. Darrell Sneed, MD FACC Stern Cardiovascular Foundation. Disclosure. Unfortunately none. Aortic Regurgitation. Causes Biscuspid AV Infective endocarditis Senile degenerative disease Collagen vascular disease VSD Subaortic stenosis Aortic root dilatation
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Aortic Regurgitation Darrell Sneed, MD FACC Stern Cardiovascular Foundation
Disclosure • Unfortunately none
Aortic Regurgitation • Causes • Biscuspid AV • Infective endocarditis • Senile degenerative disease • Collagen vascular disease • VSD • Subaorticstenosis • 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 CollCardiol. 2013;61(7):693-701 • J Am CollCardiol. 1998;32(5):1486-1582