Aortic Regurgitation

Chronic Aortic Regurgitation¶

Pathophysiology¶

• Backflow from the aorta into the LV increases LVEDV
• Causes eccentric hypertrophy increasing SV and CO
• Eventual LV dysfunction leads to heart failure
• Displacement of the PMI inferiorly and laterally

Pathology (MCC)¶

• A) Valve Deformity
  • Congenital Bicuspid Aortic Valve
    • MC Developed countries
    • Young people get AR, Old people get AS
    • May lead to valvular leaflet abnormalities or aortic root dilation
  • Rheumatic Fever
    • Rheumatic HD (MC developing countries)
  • Endocarditis
  • Degenerative Valve Disease (Myxomatous Degeneration)
  • Acromegaly
  • Ankylosing Spondylitis
  • Trauma
• B) Abnormal Aortic Root or Ascending Aorta
  • Aortic Root Dilation
    • Marfan Syndrome
      • ACEI/ARB slow disease even without Hypertension
    • Tertiary Syphilis, Ehlers-Danlos
  • Senile Aortic Disease
  • Giant Cell Arteritis
  • Relapsing Polychondritis
  • Hypertension
  • Ankylosing Spondylitis
  • Reactive Arthritis
  • Dissecting Aneurysm

Symptoms¶

• Asymptomatic mcly
• Left Ventricular failure = severe exertional dyspnea and fatigue
• Pulmonary edema

Exam¶

• Bounding pulses, head bobbing, pounding heart sensation in LLD
• Wide pulse pressure
• Hyperdynamic precordium
• Early diastolic decrescendo murmur (best heard with patient leaning forward)

Diagnosis¶

• Echocardiography: assess severity, measure aortic root, assess LV function
• CXR: LV enlargement, pulmonary edema if decompensated
• EKG: LVH, strain pattern

Treatment¶

• Asymptomatic with normal LV function
  • Serial echocardiography (annually)
  • Avoid strenuous activities
  • Treat hypertension aggressively (ACEI/ARB preferred)
• Asymptomatic with LV dysfunction
  • Aortic valve replacement
• Symptomatic
  • Aortic valve replacement
• Medical therapy
  • ACEI/ARB to reduce afterload and slow aortic root dilation
  • Beta-blockers may reduce rate of aortic root dilation (especially in Marfan)