Aortic regurgitation

PE- valvular AR(left 3rd intercostal space), root dilation(right 3rd intercostal space)

Acute

Etiology-  IE, trauma, ascending aortic dissection, syphilis

Presentation- Arterial pulsus alternans, Austin-Flint murmur, murmur at the right sternal border(for aortic dissection)

Treatment- dobutamine, dopamine, sodium nitroprusside, digoxin, (avoid beta blocker)

Chronic

Etiology- bicuspid valve, Certain weight loss medications, such as fenfluramine and dexfenfluramine, rheumatic fever, Ankylosing spondylitis, Behçet disease, Giant cell arteritis, RA, SLE, Takayasu, CTD

Presentation 

1. Becker sign – Visible systolic pulsations of the retinal arterioles 

2. Corrigan pulse (“water-hammer” pulse) – Abrupt distention and quick collapse on palpation of the peripheral arterial pulse 

3. de Musset sign – Bobbing motion of the patient’s head with each heartbeat 

4. Hill sign – Popliteal cuff systolic blood pressure 40 mm Hg higher than brachial cuff systolic blood pressure 

5. Duroziez sign – Systolic murmur over the femoral artery with proximal compression of the artery, and diastolic murmur over the femoral artery with distal compression of the artery 

6. Müller sign – Visible systolic pulsations of the uvula 

7. Quincke sign – Visible pulsations of the fingernail bed with light compression of the fingernail 

8. Traube sign (“pistol-shot” pulse) – Booming systolic and diastolic sounds auscultated over the femoral artery

Complication- LV eccentric hypertrophy(dilation), decreased coronary artery perfusion, pulmonary edema

Treatment- vasodilator (but not used in normotensive patient)

Vasodilator- long term used of severe chronic AR for LV dysfunction or LV dilation 

Surgery indication

1.Symptomatic

2.Asymptomatic+EF<50

3.Asymptomatic + LVESD>55 or LVEDD>70

Surgery- valve replacement, surgical repair, Ross procedure

Published by Steve Johnson

I am a doctor who like to organise knowledges and share ideas with others. As a doctor, a lot of knowledges influx everyday and need some patient to organise and absorb. Here was my notes to share with you and hope to save your time to know it.

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