DR.V.K.RAJAMANI

AORTIC REGURGITATION

• WHAT ARE THE SYMPTOMS OF AORTIC REGURGITATION ?

CHRONIC SEVERE AORTIC REGURGITATION:

Asymptomatic: 10-15 Years

*PALPITATION - early symptom

*HEAD POUNDING - on exertion

*EXERTIONAL DYSPNOEA

*ORTHOPNOEA

*PAROXYSMAL NOCTURNAL DYSPNOEA

*EXCESSIVE DIAPHORESIS

*ANGINA - on exertion/ at rest - nocturnal

*CCF - late

• DESCRIBE THE PULSE IN AORTIC REGURGITATION

•Corrigan’s pulse or•Water hammer pulse or•Collapsing pulse

- Rapid rise and rapid fall

•Bisferiens’s pulse -two peaks in systole

•DESCRIBE THE HEART SOUNDS IN AORTIC REGURGITATION

S1- may be soft due to premature closure of the mitral valve.

A2 –normal or accentuated when AR is due to aortic root disease.

S2- absent or single or exhibit narrow or paradoxical splitting

S3 GALLOP - due to increased LV end diastolic volume or impaired LV function

Systolic ejection sound - related to abrupt distention of the aorta by the augmented stroke volume.

•DESCRIBE THE MURMURS OF AORTIC REGURGITATION

CHRONIC AORTIC REGURGITATION

Early diastolic murmur

*High pitched, blowing decrescendo

*Best heard in the 3rd left intercostal space

-with the patient sitting up and leaning forward

-breath held in forced expiration

*Aortic root disorders- murmur is best heard along right sternal border

*Cooving or musical murmur- evertion or perforation of the aortic cusps

*Longer the duration of murmur severer the aortic regurgitation

*Becomes short - cardiac failure

Ejection systolic murmur- flow murmur

- best heard at the base of the heart. - transmitted along the carotids.

Austin flint murmur

* Soft, low pitched rumbling mid diastolic murmur. * Diastolic displacement of the anterior leaflet of the mitral valve by the aortic regurgitation stream. * Auscultatory events- intensified by handgrip.

•WHAT ARE THE PERIPHERAL SIGNS OF AORTIC REGURGITATION ?

1.Traube’s sign:

Pistol shot sounds -booming systolic and diastolic sounds heard over the femoral arteries.

2.Muller sign:

Systolic pulsations of the uvula.

3.Duroziez sign:

Systolic murmur over the femoral artery, when compressed proximally. Diastolic murmur when compressed distally.

4.Quincke sign:

capillary pulsations detected by pressing a glass slide on the lips or by transmitting a light through the patient’s fingertips or by exerting gentle pressure on the tip of a finger nail.

5.De Musset sign:

Bobbing of head with each heart beat.

6.Hill sign:

Popliteal cuff systolic pressure exceeding brachial cuff systolic pressure by more than 20 mmHg.

• How will you differentiate aortic regurgitation murmur from pulmonary regurgitation murmur ?

*Pulmonary regurgitation murmur is often heard in patients with severe pulmonary hypertension. Hence it is associated with loud P2.

*Pulmonary regurgitation murmur is better heard during inspiration while aortic regurgitation murmur is better heard during expiration.

*Aortic regurgitation murmur is often associated with peripheral signs of aortic regurgitation.

•How will you distinguish

Austin flint murmur from

Organic mitral stenosis

murmur?

*Opening snap In favour *Loud first heart sound of mitral stenosis *Loud P2 due to pulmonary hypertension

• What are the clinical signs of acute aortic regurgitation ?

•Patients with acute severe aortic regurgitation appear gravely ill

•Tachycardia

•Peripheral cyanosis

•Peripheral signs of aortic regurgitation are absent/not impressive

•Left ventricle impulse is normal

•Rocking motion of chest is absent

•Signs of pulmonary congestion/ oedema

• WHAT ARE THE CAUSES OF ACUTE AORTIC REGURGITATION?

•Infective endocarditis

•Prosthetic valve dysfunction

•Aortic dissection

•Trauma

•Systemic hypertension

• What are the causes of chronic aortic regurgitation?

*Rheumatic heart disease

*Congenital bicuspid aortic valve

*Infective endocarditis

*Aortic root dilatation

*In association with other diseases

•CONGENITAL

-VSD

-Supravalvular aortic stenosis

-Discrete subvalvular aortic stenosis

-Aneurysm of the sinus of valsalva

•CONNECTIVE TISSUE DISEASE

* Marfan’s syndrome

* Osteogenesis Imperfecta

* Ehlers-danlos syndrome

•AUTO IMMUNE DISEASES

* Ankylosing spondylitis * Rheumatoid arthritis * Systemic lupus erythematosus

•SYPHILIS

•VARIOUS FORMS OF AORTITIS OR ARTERITIS

eg: Giant cell arteritis Takayasu’s disease

•DRUGS- ANORECTIC DRUGS

*Fenfluramine *Dexfenfluramine