Aortic Regurgitation

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