Aortic Valve Regurgitation (AR)

by | Aug 1, 2015 | Cardiology

Aortic Regurgitation (AR) Acute Aortic Regurgitation Acute AR Symptoms: Acute tachycardia Acute dyspnea Acute AR Signs: Tachycardia Severe HF Sx: rales, edema Soft S1 Hypotension Diastolic murmur may be short or inaudible S3/S4 Acute Severe AR Treatment: Urgent surgical replacement (AVR) or repair Nitroprusside IV, Inotropes DO NOT use Intra-Aortic Balloon Pump (IABP) DO NOT use beta blockers or pressors     Chronic Aortic Regurgitation Chronic AR Symptoms: Prolonged asymptomatic stage, then dyspnea Chronic AR Signs: Loud decrescendo diastolic murmur at R upper sternal border (holodiastolic) +/- Austin Flint murmur Wide pulse pressure Bisferiens pulse Head nodding, capillary pulsations, pistol-shot femoral pulses, pulsatile uvula Chronic AR Etiology: Intrinsic valvular:  degenerative, calcification, bicuspid, rheumatic, connective tissue Dz, IE, myxomatous, anorectic drugs Ascending aorta:  degenerative, dissection, Marfan’s, Ehlers-Danlos, inflammatory/aortitis, giant cell arteritis A disease of LV volume and pressure overload Increased preload,  Increased afterload –> often large LV (cor bovinatum) EF is relatively unchanged with corrective surgery Echocardiography in Chronic AR: Signs of severe AR:  PHT < 200 msec, regurg vol > 60 mL,  regurg fraction > 55%, color jet > 60% LVOT Premature MV closure Flow reversal in the proximal descending thoracic aorta Treadmill in Chronic AR:  can do treadmill for estimation of exercise capacity, no need for LVEF changes Catheterization in Chronic AR: Do a cath if echo and Sx are discrepant LV pressure tracing shows gradual rise in diastole Wide pulse pressure Effacement of the dicrotic notch MRI If echo cannot diagnose AR severity, cardiac MRI (CMR) is the next modality Surgical Indications for Severe Chronic AR: Severe AR + any symptoms Severe AR + LVEF < 50%...