Aortic Regurgitation
Aortic regurgitation is diastolic reflux of blood from aorta to LV due to malposition of the aortic cusps.
RISK FACTORS
- age
- enlarged aortic root diameter: Marfans, Enhlers-Danlos, oesteogenesis imperfecta, connective tissue disorders
- bicuspid AV
- atherosclerosis
- infective endocarditis
- rheumatic heart disease
- connective tissue or inflammatory diseases
- antiphospholipid syndrome
- trauma
- ankylosing spondilitis
SYMPTOMS
- SOBOE
- angina
- LVF
EXAMINATION
- decrescendo diastolic murmur
- systolic ejection murmur (high ejection volume)
- absent second heart sound
- bounding carotid pulse
- head bobbing
- uvula pulsation
- pistol shot sounds over femoral artery
- compression of finger nails with a glass slide: capillary pulsations
ECHO
Goals
- look at anatomy of aortic valve leaflets and root
- assess severity of AR
- quantify LV size and function
Anatomy
- leaflets: bicuspid, tricuspid, vegetations, degeneration.
- annulus: size
- root: size of sinus of Valsalva, dissection
Severity
- jet width/LVOT width (< 25% = mild, >65% = severe)
MANAGEMENT
Indications for aortic valve replacement
- acute AR
- any symptoms (NYHA II or greater)
- declining EF
- declining EF with exercise
Non-surgical issues
- best to operate before LV end-diastolic diameter increases to >55 mm or 25 mm/m2 or before LVEF falls to <55%
- avoid beta-blockers (prolongs diastole)
- intra-aortic balloon pump is contra-indicated
- decrease afterload in chronic AR (improves LV function)
References
Journal articles and textbooks
- Bekeredjian R, Grayburn PA. Valvular heart disease: aortic regurgitation. Circulation. 2005 Jul 5;112(1):125-34. Review. Erratum in: Circulation. 2005 Aug 30;112(9):e124
- Austin Flint murmur. LITFL
- Aortic Regurgitation Eponymythology. LITFL
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC