aortic regurgitation
TRANSCRIPT
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