Aortic Regurgitation

Reflux of blood from the aorta through the aortic valve into the left ventricle during diastole

Aetiology

  • Can be due to valve disease - rheumatic fever, infective endocarditis, connective tissue diseases (RA/SLE), bicuspid aortic valve
  • Can be due to aortic root disease - aortic dissection, spondylarthropathis, hypertension, Marfan's, Ehler-Danlos syndrome, syphilis (rare)

Clinical presentation

Symptoms

  • Significant sumptoms occur late, do not develop until LV failure develops
  • Angina
  • Dyspnoea

Signs

  • High-pitched early diastolic murmur best heard at the left sternal edge in the fourth intercostal space with the patient leaning forwards and the breath held in expiration
  • Collapsing pulse
  • Apex beat is displaced laterally and downwards and is forceful in quality

Investigations

  • ECG
  • CXR
  • Echocardiogram is the key examination in diagnosis and quantification of AR severity
  • Others if indicated: CMR, cardiac catheterisation

Management

Medical therapy

  • Treat underlying cause if appropriate
  • Patients with acute aortic regurgitation may need treatment with vasodilators and inotropes
  • ACE inhibitors are useful in individuals with chronic severe AR and heart failure
  • Beta-blockers may slow aortic dilation in Marfan’s patients

Surgery

  • Indicated in symptomatic patients, and in asymptomatic patients when LV function begins to deteriorate
  • Surgical management involves valve replacement