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Aortic Regurgitation

by | 20 May, 2020

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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

Early diastolic murmur. Source: University of Michigan Murmur library

Causes

Acute disease

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

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