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Cardiology II (Aortic Insufficiency)
Terms in this set (28)
What is the etiology of Aortic Insufficiency (Regurgitation)?
1) Rheumatic Fever
2) Infective Endocarditis
3) Connective Tissue Diseases - SLE, RA
4) Aortic Root Disease
6) Congenital (bicuspid valve, large VSD)
7) Diseases that cause dilation of aorta - Marfan, syphilis,etc
Describe the pathophysiology of Aortic Insufficiency
AR--> Volume Overload --> LV Dilatation--> Increased SV, High SBP, Low DBP (wide pulse pressure) --> Increased Wall Tension--> Pressure Overload--> LVH
Why would you have a widened pulse pressure with aortic insufficiency (regurgitation)?
Because there is deceased pressure in the Aorta and increase pressure in the left ventricle as it tries to push out the increased blood volume
What is associated with rapid decompensation due to inability to accommodate to increased end diastolic pressure
Acute Aortic insufficiency (regurgitation)
What are the signs of Acute Aortic insufficiency (regurgitation)?
Acute pulmonary edema
What may be compensated by ventricular dilation, then hypertrophy eventually leading to CHF?
Chronic Aortic insufficiency (regurgitation)
What are the signs of Chronic Aortic insufficiency (regurgitation)?
1) Prolonged asymptomatic period
2) Widened pulse pressure
3) CHF symptoms
5) Atypical chest pain ("uncomfortable awareness of a forceful heart beat")
The following cards are all related to increased stroke volume and widened pulse pressure
Head bobbing with systole
De Musset's sign
Capillary pulsations in the nail beds
Pistol shot sounds over radial or femoral artery
To-and-fro femoral murmur
Describe the sound of Aortic Regurgitation
High-pitched, blowing diastolic murmur
Where is Aortic Insufficiency heard best?
Heard best with the diaphragm in the third left intercostal space (erb's point) with the patient sitting up, leaning forward, and exhaling
What will be noted on ECG with Aortic Insufficiency?
1) LVH (Dilation leads toe hypertrophy)
2) Strain Pattern (myocardial oxygen demand increases with hypertrophy)
4) LAE (stroke volume fills the ventricle and transits back to the atria
5) Atrial Fibrillation (Irritation of the atria)
What will a CXR be able to demonstrate about Aortic Insufficiency?
Whether it is acute (pulmonary edema) or chronic (LVH or Cardiomegaly)
What will a echocardiogram indicate in Aortic Insufficiency?
1) Quantification of Aortic Regurgitation
2) Identification of etiology
When will we need to do a cardia catheterization in a patient with Aortic regurgitation?
If the patient is having chest pain or the strain pattern on the ECG
In both mild and moderate aortic regurgitation the left ventricle size and shape remains the same, so when do we treat?
When the regurgitation becomes severe
What is the echocardiogram used for in Aortic insufficiency?
1) To confirm the presence and severity of acute or chronic AR
2) Diagnosis and assessment of the cause of chronic AR (including valve morphology and aortic root size and morphology)
3) Assessment of LV hypertrophy, dimension (or volume), and systolic function
4) Indicated in patients with an enlarged aortic root to assess regurgitation and the severity of aortic dilatation
5) Indicated for the periodic re-evaluation of LV size and function in asymptomatic patients with severe AR
6) Indicated to re-evaluate mild, moderate, or severe AR in patients with new or changing symptoms
7) Exercise stress testing for patients with chronic AR is reasonable for the evaluation of symptoms and functional capacity before participation in athletic activities (Demand increases, regurgitation causes needed blood to flow backwards and not respond to the increased need for perfusion throughout the body.)
- Results in Dyspnea
- Chest Pain
What is the medical therapy in a patient that is asymptomatic patients with mild to moderate Aortic Regurgitation?
What is the medical therapy in a patient that is asymptomatic patients with severe Aortic Regurgitation with preserved LV function or patients with symptoms or reduced LV function who are not surgical candidates?
Vasodilators (i.e. ACE inhibitors, dihydropyridine calcium channel blockers, hydralazine, etc.)
What is the only effective therapy for severe AR?
Aortic valve replacement
In acute, severe AR, what is often performed emergently (i.e. active endocarditis)
Aortic valve replacement
Chronic progression from asymptomatic --> mild --> moderate Aortic insufficiency --> Severe is
Symptomatic Aortic insufficiency
Severe acute Aortic Insufficiency
> 1 year 10-30%
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