• 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
•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 rootdisease.S2- absent or single or exhibit narrow or paradoxical splittingS3 GALLOP - due to increased LV end diastolic volume or impaired LV functionSystolic ejection sound - related to abrupt distention of the aorta by the augmented stroke volume.
CHRONIC AORTIC REGURGITATIONEarly 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 SIGNSOF 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 withsevere pulmonary hypertension. Hence it is associated with loudP2.*Pulmonary regurgitation murmur is better heard duringinspiration while aortic regurgitation murmur is better heardduring expiration.*Aortic regurgitation murmur is often associated with peripheralsigns of aortic regurgitation.
•How will you distinguish Austin flint murmur fromOrganic 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?