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Aortic Regurgitation

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

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  1. Aortic Regurgitation Darrell Sneed, MD FACC Stern Cardiovascular Foundation

  2. Disclosure • Unfortunately none

  3. 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

  4. 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

  5. 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

  6. 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

  7. Acute AI Treatment • Surgery! Dr. Brad Wolf- cardiothoracic surgery

  8. 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

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

  10. Thank you!

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