This document discusses aortic regurgitation (AR), including its etiology, pathophysiology, and clinical features. AR can be caused by primary valve disease, aortic root disease, or a combination. It may result from rheumatic fever, congenital bicuspid aortic valve, infective endocarditis, syphilis, or aortic root dilation conditions like Marfan syndrome. Pathophysiologically, AR increases left ventricular preload and afterload, leading to eccentric hypertrophy. Clinical features include a collapsing pulse, diastolic murmur, heart failure symptoms, and widened pulse pressure. A third murmur called Austin Flint may indicate severe AR with partial mitral valve closure.

1. AORTIC REGURGITATION
PASUPULETIJAHNAVI
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2. Etiology
01
Overview
Pathophysiology
02
Clinical features
03

3. Etiology
Aortic regurgitation (AR) may be caused by
primary valve disease, aortic root disease,
or their combination.
It can be classified as
1.Acute AR
2.Chronic AR

5. Primary Valve
Disease
Rheumatic disease results in thickening, deformity, and
shortening of the individual aortic valve cusps, changes
that prevent their proper opening during systole and
closure during diastole
Patients with congenital bicuspid aortic valve (BAV)
disease may develop predominant AR, and ∼20% of
these patients will require aortic valve surgery between
10 and 40 years of age

6. AR may result from infective endocarditis (IE), which can
develop on a valve previously affected by rheumatic
disease, a congenitally deformed valve, or on a normal
aortic valve, and may lead to perforation or erosion of
one or more leaflets
The aortic valve leaflets may become scarred and
retracted during the course of syphilis or ankylosing
spondylitis and contribute further to the AR that
derives primarily from the associated root dilation

7. Medial degeneration of the ascending aorta, which
may or may not be associated with other
manifestations of Marfan syndrome; idiopathic
dilation of the aorta; annuloaortic ectasia;
osteogenesis imperfecta; and severe, chronic
hypertension may all widen the aortic annulus and
lead to progressive AR
Primary Root
Aortic Disease
AR also may be due entirely to marked aortic annular
dilation, i.e., aortic root disease, without primary
involvement of the valve leaflets; widening of the aortic
annulus and lack of diastolic coaptation of the aortic
leaflets are responsible for the AR

8. THE TOTAL STROKE VOLUME EJECTED BY THE LEFT
VENTRICLE ISINCREASED INPATIENTSWITHAR.INAR,THE
ENTIRE LV STROKE VOLUME ISEJECTED INTO A HIGH PRESSURE
ZONE, THE AORTA
A NORMAL EFFECTIVE FORWARD STROKE VOLUME AND
A NORMAL LVEF TOGETHER WITHAN ELEVATED LVEDP AND
VOLUME, PRELOAD AND AFTERLOAD ARE BOTH INCREASED
THE END-DIASTOLIC VOLUME RISESFURTHER AND THE
FORWARDSTROKE VOLUME AND EJECTION FRACTION DECLINE
THE REVERSE DIASTOLIC PRESSURE GRADIENT FROM
AORTA TO LV FALLS PROGRESSIVELY DURINGDIASTOLE,
ACCOUNTING FOR THE TYPICAL DECRESCENDO NATURE OF THE
DIASTOLIC MURMUR
IN CHRONIC SEVERE AR,THE EFFECTIVE FORWARD
CARDIAC OUTPUT (CO) USUALLY ISNORMAL OR ONLY SLIGHTLY
REDUCED AT REST. LV UNDERGOES ECCENTRIC HYPERTROPHY
WITHDILATATION
Pathophysiology

9. Chronic severe AR may have a long latent period, and
patients may remain relatively asymptomatic for as long
as 10–15 years.
Uncomfortable awareness of the heartbeat, especially
on lying down, may be an early complaint
Paroxysmal nocturnal dyspnoea is sometimes the
first symptom, and peripheral oedema or angina may
occur
The characteristic murmur is best heard to the left of
the sternum during held expiration
Clinical
Features

10. Pulse: Rapid upstroke, rapid downstroke, ill sustained
peak, high volume (Collapsing pulse)
Pulsus bisferience: 2 peaks in systole (severe AR,
severe AR with mild/moderate AS, Hypertrophic
cardiomyopathy)
Widening of pulse pressure
Down and out hyperdynamic apex (Rocking motion)
The regurgitant jet causes fluttering of the mitral valve
and, if severe, causes partial closure of the anterior
mitral leaflet, leading to functional mitral stenosis and a
soft mid-diastolic (Austin Flint) murmur.

11. Heart sounds:
S1: Premature closure causes soft S1
S2: Loud S2 in root causes and soft in valve causes
S3: LV failure
S4: absent
Early diastolic murmur
High pitched soft blowing decrescendo murmur
starting with A2 and intensity decreases with fall in
gradient
Severity of AR correlates with duration of murmur
Heard in sitting and leaning forward position

13. A third murmur sometimes heard in patients with severe
AR is the Austin Flint murmur, a soft, low-pitched,
rumbling mid-to-late diastolic murmur
It is probably produced by the diastolic displacement of
the anterior leaflet of the mitral valve by the AR stream
and is not associated with hemodynamically significant
mitral valve obstruction
Intensified by handgrip
Other murmurs: Cole Cecil (AR murmur radiating to
axilla)

14. Thank's For
Watching