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Aortic Regurgitation Pathophysiology Explained
- 1. AORTIC REGURGITATION - PATHOPHYSIOLOGY Dr Kunwar Sidharth Saurabh
- 3. ETIOLOGY
- 6. PATHOPHYSIOLOGY • VOLUME LOAD – COMPENSATORY MECHANISMS – LV END DIASTOLIC VOLUME INCREASES TO ACCOMMODATE REGURGITANT VOLUME – ALONG WITH INCREASE IN CHAMBER COMPLIANCE – HENCE, THERE IS NO INCREASE IN DIASTOLIC FILLING PRESSURE
- 7. Cont.. – INCREASE IN EDV INCREASE TOTAL STROKE VOLUME – HENCE, FORWARD STROKE VOLUME MAINTAINED WITHIN NORMAL RANGE – ALSO, ADAPTATION TO VOLUME OVERLOAD IS BY NEW SARCOMERES CAUSING “ECCENTRIC LV HYPERTROPHY”
- 8. Cont.. LV PRELOAD INCREASES PRELOAD AT SACRCOMERE LEVEL IS NEAR NORMAL CONTRACTILE FUNCTION PRESERVED ENHANCED TOTAL STROKE VOLUME
- 9. Cont.. LV PRELOAD RESERVE MAINTAINED LV EJECTION PERFORMANCE MAINTAINED FRACTIONAL SHORTENING REMAINS IN NORMAL RANGE
- 10. Cont.. AUGMENTED CHAMBER VOLUME INC SYSTOLIC WALL STRESS AND AFTERLOAD AFTERLOAD INCREASE IN STIMULUS FOR CONCENTRIC HYPERTROPHY
- 11. Cont.. • THUS “AR – CHRONIC” IS A CONDITION OF COMBINED – VOLUME OVERLOAD – PRESSURE OVERLOAD • HENCE THERE IS BOTH – – ECCENTRIC HYPERTROPHY – CONCENTRIC HYPERTROPHY
- 12. POINTS TO NOTE - • DUE TO COMPENSATORY PROCESSES- – PATIENT MAY REMAIN ASYMPTOMATIC FOR DECADES – AFTER LOAD REDUCTION THERAPY HAS POTENTIAL TO REDUCE DEGREE OF REGURGITATION VIA – • REDUCES AFTERLOAD AND COMPENSATORY DILATATION AND HYPERTROPHY
- 13. Cont.. • In some patients compensatory process cannot be maintained for long • Results in LV systolic dysfunction • Symptoms of dyspnoea and fatigue often develops at this transition point. • Process is mostly insiduos
- 14. IMPORTANT TO NOTE LV SYSTOLIC DYSFUNCTION AFTERLOAD MISMATCH REVERSIBLE AVR CAUSES COMPLETE REVERSAL IMPAIRED MYOCARDIAL CONTRACTILITY IRREVERSIBLE