The diastolic leakage of blood from the aorta into the left ventricle (LV).
Chronic aortic regurgitation (AR) may be asymptomatic for years until overt symptoms of congestive heart failure develop. Initial symptoms can include palpitations and uncomfortable awareness of the pounding heart when lying on the left side.
Acute AR is a medical emergency, presenting with sudden onset of pulmonary oedema and hypotension or cardiogenic shock. May also present as myocardial ischaemia or aortic root dissection.
Echocardiography is the best non-invasive test to diagnose and grade the severity of AR.
Vasodilator therapy improves haemodynamics and delays the need for aortic valve replacement/repair (AVR) in asymptomatic patients with chronic severe AR.
AVR is indicated in symptomatic patients or those with LV ejection fraction <50%, and asymptomatic patients with severe AR if LV end-diastolic volume is >75 mm or LV end-systolic volume is > 55mm.
Aortic regurgitation (AR) is the diastolic leakage of blood from the aorta into the left ventricle. It occurs due to inadequate coaptation of valve leaflets resulting from either intrinsic valve disease or dilation of the aortic root. It can remain asymptomatic for decades before patients present with irreversible myocardial damage.
History and exam
- paroxysmal nocturnal dyspnoea
- mottled extremities
- rapid and faint peripheral pulse
- jugular venous distension
- basal lung crepitations
- altered mental status
- urine output <30 mL/hour
- soft S1
- soft or absent A2
- collapsing (water hammer or Corrigan's) pulse
- displaced, hyperdynamic apical impulse
- chest pain
- pink frothy sputum
- wheeze (cardiac asthma)
- additional heart sounds
- ejection systolic flow murmur
- Austin Flint murmur
- systolic thrill
- Hill's sign
- bisferiens pulse
- de Musset's sign
- Muller's sign
- Traube's sign
- Quincke's sign
- Duroziez's sign
- Mayen's sign
- Lighthouse sign
- Becker's sign
- Landolfi's sign
- Rosenbach's sign
- Gerhardt's sign
- Lincoln's sign
- Sherman's sign
- palmar click
Sanjeev Wasson, MD
Department of Cardiology
Skagit Valley Hospital
SW declares that he has no competing interests.
Nishant Kalra, MD
Associate Faculty Member
Department of Cardiology
University of Arizona
NK declares that he has no competing interests.
Kul Aggarwal, MD, MRCP, FACC, FACP
Professor of Clinical Medicine
University of Missouri-Columbia
Harry S. Truman Veterans Hospital
KA declares that he has no competing interests.
Rajdeep Khattar, DM, FRCP, FACC, FESC
Consultant Cardiologist and Honorary Senior Clinical Lecturer
Manchester Heart Centre
Central Manchester and Manchester Children's NHS Foundation Trust
RK declares that he has no competing interests.
John Pepper, MChir FRCS
Consultant Cardiac Surgeon
Department of Surgery
Royal Brompton Hospital
JP declares that he has no competing interests.
2018 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement: A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons external link opens in a new windowMore guidelines
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