AI
Physical examination[edit]
Phonocardiograms from normal and abnormal heart sounds
The physical examination of an indivi...
returning to the heart (the wrong way) from the aorta through the incompetent
aortic valve, although the usefulness of som...
Unfortunately, none of the above putative signs of aortic insufficiency is of utility
in making the diagnosis,[12]
but the...
leads to a strong and forceful pulse (bounding pulse). Over time, the heart
becomes less able to pump blood to the body.
I...
Exams and Tests
Signs may include:
A heart murmur when the health care provider listens to the chest with a
stethoscope
A ...
given to prevent an infection of the damaged heart. However, antibiotics are now
used much less often before dental work a...
Ai
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Ai

  1. 1. AI Physical examination[edit] Phonocardiograms from normal and abnormal heart sounds The physical examination of an individual with aortic insufficiency involves auscultation of the heart to listen for the murmur of aortic insufficiency and the S3 heart sound (S3 gallop correlates with development of LV dysfunction).[2] The murmur of chronic aortic insufficiency is typically described as early diastolic and decrescendo, which is best heard in the third left intercostal space and may radiate along the left sternal border. If there is increased stroke volume of the left ventricle due to volume overload, an ejection systolic 'flow' murmur may also be present when auscultating the same aortic area. Unless there is concomitant aortic valve stenosis, the murmur should not start with an ejection click. There may also be an Austin Flint murmur,[2] a soft mid-diastolic rumble heard at the apical area. It appears when regurgitant jet from the severe aortic insufficiency renders partial closure of the anterior mitral leaflet. Peripheral physical signs of aortic insufficiency are related to the high pulse pressure and the rapid decrease in blood pressure during diastole due to blood
  2. 2. returning to the heart (the wrong way) from the aorta through the incompetent aortic valve, although the usefulness of some of the eponymous signs has been questioned:[9] large-volume, 'collapsing' pulse also known as: o Watson's water hammer pulse o Corrigan's pulse (rapid upstroke and collapse of the carotid artery pulse) low diastolic and increased pulse pressure de Musset's sign (head nodding in time with the heart beat) Quincke's sign (pulsation of the capillary bed in the nail; named for Heinrich Quincke) Traube's sign (a 'pistol shot' systolic sound heard over the femoral artery; named for Ludwig Traube) Duroziez's sign (systolic and diastolic murmurs heard over the femoral artery when it is gradually compressed with the stethoscope) Also, these are usually less detectable in acute cases.[7] Less used signs include:[10] Lighthouse sign (blanching & flushing of forehead) Landolfi's sign (alternating constriction & dilatation of pupil) Becker's sign (pulsations of retinal vessels) Müller's sign (pulsations of uvula) Mayen's sign (diastolic drop of BP>15 mm Hg with arm raised) Rosenbach's sign (pulsatile liver) Gerhardt's sign (enlarged spleen) Hill's sign - a ≥ 20 mmHg difference in popliteal and brachial systolic cuff pressures, seen in chronic severe AI. Considered to be an artefact of sphygmomanometric lower limb pressure measurement.[11] Lincoln sign (pulsatile popliteal) Sherman sign (dorsalis pedis pulse is quickly located & unexpectedly prominent in age>75 yr) Ashrafian sign (Pulsatile pseudo-proptosis)[10]
  3. 3. Unfortunately, none of the above putative signs of aortic insufficiency is of utility in making the diagnosis,[12] but they may help as pointers. What is of value is hearing a diastolic murmur itself, whether or not the above signs are present. Treatment Indications for surgery for chronic severe aortic insufficiency[13] Symptoms Ejection fraction Additional Findings Present (NYHA II[7] -IV) Any Absent > 50% Abnormal exercise test, severe LV dilatation (systolic ventricular diameter >55 mm[7] ) Absent <=50 % Cardiac surgery for other cause (i.e.: CAD, other valvular disease, ascending aortic aneurysm) Aortic insufficiency <span>To use the sharing features on this page, please enable JavaScript.</span> Email this page to a friendShare on facebookShare on twitterBookmark & SharePrinter-friendly version Aortic insufficiency is a heart valve disease in which the aortic valve does not close tightly. This leads to the backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (a chamber of the heart). Causes Aortic insufficiency can result from any condition that keeps the aortic valve from closing all the way. A small amount of blood comes back each time the heart beats. The condition causes widening (dilation) of the left lower chamber of the heart. Larger amounts of blood leave the heart with each squeeze or contraction. This
  4. 4. leads to a strong and forceful pulse (bounding pulse). Over time, the heart becomes less able to pump blood to the body. In the past, rheumatic fever was the main cause of aortic insufficiency. Now that antibiotics are used to treat rheumatic fever, other causes are more commonly seen. Causes of aortic insufficiency may include: Ankylosing spondylitis Aortic dissection Congenital (present at birth) valve problems, such as bicuspid valve Endocarditis High blood pressure Marfan syndrome Reiter syndrome Syphilis Systemic lupus erythematosus Aortic insufficiency is most common in men between the ages of 30 and 60. Symptoms Aortic insufficiency often has no symptoms for many years. Symptoms may occur slowly or suddenly. Bounding pulse Chest pain, angina type (rare) o Under the chest bone; pain may move to other areas of the body, most often the left side of the chest o Crushing, squeezing, pressure, tightness o Pain increases with exercise and goes away with rest Fainting Fatigue Palpitations (sensation of the heart beating) Shortness of breath with activity or when lying down Swelling of the feet, legs, or abdomen Uneven, rapid, racing, pounding, or fluttering pulse Weakness, more often with activity
  5. 5. Exams and Tests Signs may include: A heart murmur when the health care provider listens to the chest with a stethoscope A very forceful beating of the heart The head may bob in time with the heartbeat Hard pulses in the arms and legs Low diastolic blood pressure Signs of fluid in the lungs Aortic insufficiency may be seen on: Aortic angiography Echocardiogram – ultrasound examination of the heart Left heart catheterization MRI of the heart Transesophageal echocardiogram (TEE) A chest x-ray may show swelling of the left lower heart chamber. Lab tests cannot diagnose aortic insufficiency, but they may be used to rule out other disorders or causes. Treatment If there are no symptoms or if symptoms are mild, you may only need to get an echocardiogram from time to time and be monitored by a health care provider. If your blood pressure is high, then treatment with certain blood pressure medications may help slow the worsening of aortic regurgitation. ACE inhibitor drugs and diuretics (water pills) may be prescribed for more moderate or severe symptoms. In the past, most patients with heart valve problems were given antibiotics before dental work or an invasive procedure, such as colonoscopy. The antibiotics were
  6. 6. given to prevent an infection of the damaged heart. However, antibiotics are now used much less often before dental work and other procedures. You may need to limit activity that requires more work from your heart. Talk to your health care provider. Surgery to repair or replace the aortic valve corrects aortic insufficiency. The decision to have aortic valve replacement depends on your symptoms and the condition and function of your heart. You may also need surgery to repair the aorta if it is widened. Outlook (Prognosis) Aortic insufficiency is curable with surgical repair. This can completely relieve symptoms, unless severe heart failure is present or other complications develop. Without treatment, patients with angina or congestive heart failure due to aortic insufficiency do poorly. Possible Complications Abnormal heart rhythms Heart failure Infection in the heart When to Contact a Medical Professional Call your health care provider if: You have symptoms of aortic insufficiency You have aortic insufficiency and symptoms worsen or new symptoms develop, especially chest pain, difficulty breathing, or edema (swelling) Prevention Blood pressure control is very important if you are at risk for aortic regurgitation. Alternative Names Aortic valve prolapse; Aortic regurgitation

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