Diagnosis
Aortic regurgitation
Leakage of the aortic valves resulting in reverse blood flow from the aorta into the left ventricle during diastole.
Also known as: Aortic insufficiency, Aortic valve insufficiency, Aortic valve regurgitation
Etiology
Cause [iqg]
Aortic root dilatation: Hypertension, age, cystic medial necrosis, Marfan syndrome, osteogenesis imperfecta), ankylosing spondylitis, Behcet syndrome, psoriatic arthritis, reactive arthritis, ulcerative colitis, relapsing polychondritis, and giant cell arteritis
Valvular disease: Rheumatic heart disease, endocarditis, degenerative calcification, traumatic leaflet rupture, congenital bicuspid aortic valve, ventricular septal defect with valve prolapse, myxomatous degeneration, membranous subaortic stenosis, complication of percutaneous aortic balloon valvotomy and transcatheter aortic valve replacements, traumatic rupture of an aortic cusp, complications to diseases: systemic lupus erythematosus, Takayasu disease, Whipple disease, rheumatoid arthritis, ankylosing spondylitis, Jaccoud arthropathy, syphilis, Crohn disease, and appetite-suppressing drugs
Proximal aortic root dissection: Cystic medial necrosis, Marfans syndrome, syphilis, hypertension, Ehlers-Danlos, Turner syndrome, third trimester
Pathophysiology [iqg]
Aortic regurgitation --> increased preload and increased LV systolic tension --> Left Ventricle dilation --> compensating eccentric hypertrophy --> increased stroke volume --> increased afterload --> wall thickening fails to keep pace with the hemodynamic load --> decreased compliance --> decline in systolic function and ejection fraction --> Chronic Heart Failure
Risk factors
Hypertension
Aging
Marfan syndrome
Turner’s syndrome
Epidemiology
Prevalence per 100.000 [igd][iqg][gfm][zmw]
Incidence per 100.000 [igd][iqg][gfm][zmw]
Symptoms & findings
Symptoms
Confusion, Corrigan's sign, Crepitations, Cyanosis, De Musset's sign, Diastolic murmur, Dizziness, Duroziez's sign, Dyspnea, Fatigue, Heart murmur, Hill's sign, Orthopnea, Pulsus bisferiens, Quincke's sign, Syncope, Tachypnea, Third heart sound, Weakness, Wheezing, Wide pulse pressure
Clinical findings
Cardiomegaly, Elevated BNP, High voltage QRS, Hypoxemia, Pulmonary congestion, Pulmonary edema
Anamneses
None listed.
Localized findings
Approach
Blood test: BNP
ECG
Echocardiography
Cardiac MRI
Coronary Angiography
Treatment
Treat hypertension: vasodilator (calcium channel blockers or ACEI/ARB) [iqg] [qd0]
Asymptomatic patients with mild or moderate AR with normal cardiac size
--> echocardiography every 12 or 24 months
Symptomatic AR -> Aortic valve replacement
Transcatheter aortic valve replacement (TAVR)
Open surgery
Differential diagnoses
Anemia, Aortic stenosis, Hyperthyroidism, Mitral regurgitation, Mitral stenosis, Tricuspid stenosis
References
[1] Dewaswala N, Chait R. Aortic Regurgitation. [Updated 2023 Aug 8]. https://www.ncbi.nlm.nih.gov/books/NBK555944/
[2] Andell et al. Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study. Heart. 2017 Nov;103(21):1696-1703.
[3] Singh et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol. 1999 Mar 15;83(6):897-902.
[4] Brennan et al. Contemporary Prevalence of valvular heart disease & Diagnostic Variability across Centers. J Am Coll Cardiol. 2022 Mar, 79 (9_Supplement) 1723.
[5] http://emedicine.medscape.com/article/150490 (2014-01-02); [Medscape]
[6] [First Aid for the Surgery Clerkship]
[7] [Legemiddelhandboka.no]
[8] Nkomo et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006 Sep 16;368(9540):1005-11.
[9] Iung et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003 Jul;24(13):1231-43.