Definition
It is a congenital defect of the heart in which the Aortic Valve of the heart does not close tightly causing the regurgitation of blood from the aorta to the left ventricle during ventricular diastole.
Causes of Aortic Regurgitation
• Chronic rheumatic heart disease.
• Infective endocarditis.
• Syphilitic aortitis.
• Bicuspid aortic valve.
• Dissecting aneurysm affecting ascending aorta.
• Hypertension (by aortic dilatation).
• Marfan’s syndrome.
• Seronegative arthritis (ankylosing spondylitis, Reiter’s syndrome).
• Rheumatoid arthritis.
• Cystic medial necrosis.
• Congenital.
Symptoms
• May be asymptomatic.
• Symptoms may be—palpitation, shortness of breath on exertion, occasional cough, anginal
pain.
Signs
• Pulse—high volume, collapsing.
• Dancing carotid pulse in the neck (Corrigan’s sign).
• BP—High systolic, low diastolic and wide pulse pressure.
Precordium Examination:
• Inspection:
–– Visible cardiac impulse.
• Palpation
–– Apex beat—shifted, thrusting in nature.
–– Diastolic thrill may be present in left parasternal area.
• Auscultation
–– 1st heart sound—normal in all the areas.
–– 2nd heart sound—A2 is absent and P2 is normal.
–– Early diastolic murmur in left lower parasternal area with patient bending forward and
breathing hold after expiration.
–– ESM may be present in aortic area due to increased flow.
Formula of 3 to Diagnose AR
• 3 pulse—collapsing (water hammer), dancing carotid and capillary pulsation.
• 3 BP—rise of systolic, fall of diastolic and wide pulse pressure.
• 3 murmur—early diastolic murmur, Austin Flint murmur and ejection systolic murmur.
Investigations
• X-ray chest shows cardiomegaly.
• ECG (LVH).
• Echocardiogram, preferably colour Doppler.
• Cardiac catheterisation.
• Other investigations to find out cause.
Complications
• Acute LVF.
• Infective endocarditis.
• Arrhythmia.
Treatment
• In mild asymptomatic case—follow-up.
• In asymptomatic moderate to severe AR with normal LV function—long acting nifedipine.
• In symptomatic patient with—
–– Normal LV function—long acting nifedipine.
–– LV dysfunction—digitalis, ACE inhibitor, diuretic.
–– Heart failure—digitalis, ACE inhibitor, diuretic.
• In severe case—valve replacement.
Indications of Surgery
• Symptomatic patient.
• Asymptomatic patient with—
–– LV systolic dysfunction (EF <50%)
–– LV dilatation (LV end-systolic dimension >55 mm or LV end-diastolic dimension >75 mm).
–– Aortic root dilatation >50 mm.