Medical Presentation

1. AORTIC REGURGITATION
DONE BY : NOEL CHRISTIAN

2. DEFINITION
 Aortic Regurgitation (AR), is due to damage or dysfunction of the aortic valve
of the heart that causes blood to flow in the reverse direction during
ventricular diastole, from the aorta into the left ventricle. As a consequence
the cardiac muscle is forced to work harder than normal.

4. SIGNS AND SYMPTOMS
 Symptoms of aortic insufficiency are:
1) Dyspnea on exertion
2) Orthopnea
3) Palpitations
4) Chest pain
5) Cyanosis (in acute cases)
 In the long run, blood can accumulate the left
atrium and cause congestion in the lungs then after
years there can be congestion in the right atrium.

5. CAUSES
 Over 80% of cases are idiopathic, but otherwise may result from
1) Aging
2) Aortic dissection
3) Reactive arthritis
4) Systemic hypertension
5) Infective endocarditis
 Other Genetic dispositions.
 Left Ventricular Heart Failure due to AR, due to congestion in the lungs,
right ventricle becomes dilated called Biventricular or globular heart
failure and patient will require transplantation.

6. PATHOPHYSIOLOGY
 The mechanism of aortic regurgitation (AR), comprises the pressure in the left
ventricle decreases below the pressure in the aorta, the aortic valve is not able to
completely close. This causes a leaking of blood from the aorta into the left ventricle.
This means that some of the blood that was already ejected from the heart
is regurgitating back into the heart.
 This regurgitant flow causes a decrease in the diastolic blood pressure in the
aorta, and therefore an increase in the pulse pressure. Since some of the blood that
is ejected during systole, regurgitates back into the left ventricle during diastole,
there is decreased effective forward flow.
 Aortic regurgitation causes volume overload.
 The volume overload causes left ventricular hypertrophy (LVH).

7. COMPLICATIONS
 Heart failure may become severe and life-threatening.
 Infection of the valve (endocarditis) is an uncommon complication. (Abnormal
valves are more prone than normal valves to infection.) Unless promptly treated,
endocarditis can cause serious illness.

8. DIAGNOSIS
 The diagnosis of aortic regurgitation a common test for the evaluation of the
severity is echocardiography.
 Chest X-ray can assist in making the diagnosis, showing left ventricular
hypertrophy and dilated aorta.
 ECG typically indicates left ventricular hypertrophy.
 Cardiac chamber catheterization assists in assessing the severity of
regurgitation and any left ventricular dysfunction.

10. PATIENTS COMPLAINTS
 Characteristic Signs:
 Chest pain (angina) when patient exerts. (This occurs because of reduced blood flow
to the coronary arteries.)
 Forceful heartbeats which they may feel as the sensation of having a 'thumping heart'
(palpitations).
 Dizziness.
 Shortness of breath, tiredness and fluid retention in various tissues of the body if the
patient has developed heart failure.

11. INSPECTION
 De muse or symptom of muse - nodding of the head
 Corrigan’s sign – dancing of carotid artery
 Miosis and mydriasis – pupil contraction and dilation
 Quincke’s sign – blood filling under the nails
 *After hypertrophy characteristics signs appear

12. PALPATION
 During AR, there is more blood in the left ventricle. Therefore, the left ventricle has to
work harder in order to pump blood into the aorta. In due time, the left ventricle
undergoes hypertrophy and the point of maximal impulse - will move to the left
and down.

14. PERCUSSION
 Left ventricle hypertrophy. (left border enlarges)

15. AUSCULTATION
 The murmur of AR occurs in diastole (diastolic murmur), usually as a high-
pitched sound that is loudest at the left sternal border. The duration of the
murmur correlates better with the severity of AR than does the loudness of
the murmur.
 Systolic dysfunction
 Auscultation may reveal an S3 gallop if LV dysfunction is present.

16. MEDICATION
 If the backflow of blood is mild and you have no symptoms then you may not need any
treatment. If you develop symptoms or complications, various medicines may be advised to
ease the symptoms. Surgery may be advised if symptoms become worse.
 Medication may be advised to help ease symptoms of heart failure if heart failure develops.
For example:
 Diuretics usually help if you are breathless. They make the kidneys produce more urine. This
gets rid of excess blood and fluid which may build up in the lungs or other parts of the body
with heart failure.
 Angiotensin-converting enzyme (ACE) inhibitors are medicines which help to reduce the
amount of work the heart does and to ease symptoms of heart failure.
 Antibiotics to prevent endocarditis.

17. REFERENCES
 Bekeredjian, Raffi; Grayburn, Paul A. (2005-07-05). "Valvular Heart Disease Aortic
Regurgitation“. Circulation. 112 (1): 125–134. doi:10.1161/CIRCULATIONAHA.104.488825. ISSN 0009-
7322. PMID 15998697.
 Jump up^ "Aortic Regurgitation. Healt "Aortic insufficiency: MedlinePlus Medical
Encyclopedia". www.nlm.nih.gov. Retrieved 2016-05-16.
 ^ Jump up to:a b c d e f g h i Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart
Disease in: Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series).
Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6.
 h Information and treatment | Patient". Patient. Retrieved 2016-06-04.
 Kumar, Vinay; Abbas, Abul K.; Aster, Jon C. (2012-05-01). Robbins Basic Pathology. Elsevier Health
Sciences. p. 331. ISBN 1455737879.
 Jump up^ Topol, Eric J.; Califf, Robert M. Textbook of Cardiovascular Medicine. Lippincott Williams &
Wilkins. p. 381. ISBN 9780781770125 Retrieved 4 June 2016.