Aortic Regurgitation
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
ClinicalFeatures
- It is a condition characterized by retrograde blood flow into the left ventricle due to an incompetent aortic valve or dilated valve ring.
- Usually only becomes symptomatic late in disease when LV failure develops.
- Common symptoms include dyspnea, orthopnea, PND, syncope, anginal pain.
- On examination there is heaving with displaced apex beat. Pulse is large volume & collapsing ( water- hammer pulse ). There is high - pitched early diastolic decrescendo murmur at left sternal border.
Investigations
- ECG shows left atrial enlargement and LVH
- CXR shows LVH, LAE and aortic root dilatation
- Echocardiography is done to quantify AR, leaflet or aortic root anomalies
- Catheterization is recommended if patient age > 40 years and is a surgical candidate - to assess for ischemic heart disease Exercise testing shows hypotension with exercise.
Management
- The main goal of medical therapy is to reduce systolic hypertension, ACE - I are helpful.
- Every 6-12 months monitoring with echocardiography.
- Indications for surgery are
- Increasing symptoms
- IE refractory to medical therapy.
- Enlarging heart on CXR / echocardiography.
- ECG deterioration (T - wave inversion in lateral leads).
- Aim to replace the valve before significant LV dysfunction occurs