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Pathology
Blood flows back into LV from aorta leading to high pressure LV, LV dilatation
and increased myocardial oxygen demand
Aetiology
Aortic Root: Marfan’s syndrome, dissecting aortic aneurysm, systemic HTN,
aortic root dilatation, syphilis, connective tissue diseases
Valve: Congenital abnormalities (bicuspid AV, large VSD), connective tissue diseases, rheumatic fever, endocarditis.
Acute: Infective endocarditis, Aortic dissection, Acute rheumatic fever, Prosthetic valve failure
Signs
Chest: heaving, displaced apex beat, diastolic thrill, 3rd heart sound
Early diastolic, high pitched murmur: best heard at lower left sternal edge
with patient sat forward
Austin-Flint murmur: Mid-diastolic murmur at apex due to fluttering
of mitral valve leaflets with regurgitant flow
Water hammer pulse: Bounding and rapidly collapsing pulse
Wide pulse pressure: High systolic and low diastolic blood pressure
Bisferiens Pulse: Twice beating in systole; presence of combined AS/AR
de Musset’s Sign: Head bobbing in time with pulse
Corrigan’s Sign: Visible carotid pulsations
Quincke’s Sign: Visible pulsation of nail beds
Traube’s Sign: Pistol shot diastolic and systolic sounds heard with the
stethoscope lightly applied over the femoral artery
Duroziez’s Test: Light proximal compression of femoral artery produces a systolic diastolic murmur over femoral artery
Symptoms
Dyspnoea, fatigue, orthopnoea, PND, palpitations
Investigations
ECG: Left Ventricular Hypertrophy ,Left Atrial Enlargement, left axis deviation
Chest X-Ray: Left Atrial and Ventricular Enlargement, Aortic root dilatation
Echo: Gold standard – assesses for valvular and leaflet abnormalities
Cardiac catheterisation
Coronary angiography: Indicated if age > 40
Treatment
Medical: Treat chronic heart failure.
Acute aortic regurgitation may require stabilisation with vasodilators
Surgical: Aortic valve replacement
Prognosis
Once symptomatic poor prognosis
Arrhythmias, CHF, prosthetic valve failure
Key Facts
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Key Images
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Key References
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