Aortic Regurgitation

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Aortic Regurgitation

Causes

Chronic

• congenital
• connective tissue disorders
  • Marfan's
• rheumatic fever
• Syphilis
• aortitis (Takayashu)
• Ankylosing Spondylitis
• Reiter's Syndrome
• rheumatoid arthritis
• systemic lupus erythematosus

Acute

• Infective endocarditis
• Trauma

Pathology

• dilatation and hypertrophy

Examination

• introduce and expose
• observation
  • features of Marfan's Syndrome
  • Ankylosing Spondylitis
• Hands
  • splinters
  • Rheumatoid hands
  • Arachnodactyly
  • Quincke's Sign
• Pulse
  • sinus rhythm
  • Collapsing
• BP
  • wide pulse pressure
  • for example 180 / 60
• neck
  • large volume carotid pulse easily seen in neck (not JVP)
  • De Musset's sign
  • Corrigans sign
• face
  • high arched palate 
  • Argyll-Robertson pupils
• Praecordium
  • Inspect 
    • Visible Apex beat
  • Palpate 
    • Displaced Thrusting Apex beat 
  • Auscultate
    • Soft blowing early diastolic murmur 
      • left sternal edge
      • Heard loudest sitting forward in held expiration
    • Plus systolic murmur (as increased flow)
    • +/- Austin-Flint murmur
      • mid-late diastolic
      • backflow hits mitral valve
• Lung Bases 
  • normal unless complicated

Investigations

• echocardiography follow-up
  • increase in ventricular diameter > 50mm needs operation
  • increase 41-49mm leads to LV dysfunction in 1-6% / year
  • increase < 40 mm no symptoms

Treatment

• vasodilators - prolong time to surgery
  • nifedipine
  • ACE-inhibitors
• Don't use beta-blockers if reduced heart rate

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