Valvular Heart Diseases : Aortic Regurgitation/Insufficiency

Aetiology (Causes)

     Bicuspid valve or disproportionate cusps
     Rheumatic disease
     Infective endocarditis
     Failure of prosthetic heart valve
     Aortic dilatation (Marfan's syndrome, aneurysm, dissection, syphilis, ankylosing spondylitis)


Mild to moderate AR
Often asymptomatic
     Awareness of heart beat, 'palpitations'
     Severe AR
       Large volume or ‘collapsing pulse’
       Low diastolic and increased pulse preassure
       Bounding peripheral pulses- A rapidly rising "water-hammer" pulse, which collapses suddenly as arterial pressure falls rapidly during late systole and diastole (Corrigan's pulse)
       Capillary pulsations, an alternate flushing and paling of the skin at the root of the nail while pressure is applied to the tip of the nail (Quincke's pulse/sign)
       Femoral bruit (‘pistol shot’)- Duroziez’s sign/ Traube’s sign
       Head nodding with pulse- de Musset’s sign

          Early diastolic murmur
          Systolic murmur (increased stroke volume)
          Austin Flint murmur (soft mid-diastolic)
Other signs
          Displaced, heaving apex beat (volume overload)
          Pre-systolic impulse
          Fourth heart sound
          Pulmonary venous congestion (crepitations)


           Initially normal, later LV hypertrophy and T-wave inversion
Chest X-ray –
           Cardiac dilatation, maybe aortic dilatation
           Features of left heart failure
Echo Dilated left ventricle
           Hyperdynamic left ventricle
           Fluttering anterior mitral leaflet
           Doppler detects reflux
Cardiac catheterisation (may not be required)
          Dilated LV
          Aortic regurgitation
          Dilated aortic root


Treat the cause- underlying conditions like endocarditis or syphilis.
Nefidipine or ACE inhibitors to lower the systolic blood preassure.
If end systolic dimension of left ventrical is =>55mm then- Aortic valve replacement is undertaken.
Aortic root replacement – in aortic root dilatation (eg. Marfan syndrome)

Essentials of Diagnosis
Usually asymptomatic until middle age; presents with left-sided failure or chest pain.
Wide pulse pressure.
Hyperactive, enlarged LV.
Diastolic murmur along left sternal border.
ECG shows LVH; radiograph shows LV dilation.
Echocardiography/Doppler is diagnostic.
Afterload reduction is beneficial if the LV is dilated (LV end-diastolic dimension > 5.0 cm).
Surgery indicated for symptoms, EF < 55%, or LV end-systolic dimension > 5.0 cm.