Aortic Regurgitation

Aortic regurgitation (AR) is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole.

Causes

It can be caused either by disease of the aortic valve or by distortion or dilation of the aortic root and ascending aorta.

	Causes of AR due to valve disease	Causes of AR due to aortic root disease
Chronic presentation	• rheumatic fever: the most common cause in the developing world
• calcific valve disease
• connective tissue diseases e.g. rheumatoid arthritis/SLE
• bicuspid aortic valve (affects both the valves and the aortic root)	• bicuspid aortic valve (affects both the valves and the aortic root)
• spondylarthropathies (e.g. ankylosing spondylitis)
• hypertension
• syphilis
• Marfan's, Ehler-Danlos syndrome
Acute presentation	• infective endocarditis	aortic dissection

Features

early diastolic murmur: intensity of the murmur is increased by the handgrip manoeuvre
collapsing pulse
wide pulse pressure
Quincke's sign (nailbed pulsation)
De Musset's sign (head bobbing)
mid-diastolic Austin-Flint murmur in severe AR - due to partial closure of the anterior mitral valve cusps caused by the regurgitation streams

Suspected AR should be investigated with echocardiography.

Management

medical management of any associated heart failure
surgery: aortic valve indications include
- symptomatic patients with severe AR
- asymptomatic patients with severe AR who have LV systolic dysfunction

Aortic Regurgitation

Causes

Features

Approach

Hx