Introduction
Aortic regurgitation refers to leaking of the aortic valve during diastole such that blood returns to the left ventricle from the aorta.
Murmur
Sound: Early diastolic murmur
Loudest region: Left sternal edge
Accentuation: Expiration, leaning forwards
Early diastolic murmur
Early diastolic murmur. Source: University of Michigan Murmur library
Causes
Acute disease
- Infective endocarditis
- Aortic dissection
- Trauma
Chronic disease
- Rheumatic fever
- Connective tissue disease e.g. rheumatoid arthritis
- Aortic dilation:
- Marfan’s syndrome
- Hypertension
- Aortitis:
- Syphilis
- Ankylosing spondylitis
- Vasculitis
Additional and eponymous signs
- Collapsing pulse
- Wide pulse pressure
- Corrigan’s: Prominent carotid pulsation
- Austin Flint: Mid-diastolic murmur loudest in mitral region
- Quincke’s: Blanching of fingernails with each pulse
- De Musset’s: Rhythmic head bobbing with each pulse
- Traube’s sign: Pistol-shot sound when auscultating the femoral artery
Investigations
- Echocardiogram
- ECG: may show left ventricular hypertrophy
- Chest x-ray
- Blood cultures, if considering infective endocarditis
Management
Asymptomatic patients should be managed conservatively with regular echocardiogram follow-up. Treat any underlying causes, such as hypertension.
Surgical management should be offered in cases with:
- Symptomatic patients
- Left ventricular enlargement or reduced ejection fraction
- Aortic dissection
- Infective endocarditis
0 Comments