Leaking of blood back through the aortic valve. Patients often present with symptoms of breathlessness and then develop other symptoms of heart failure and can develop angina.
Signs:
- Collapsing/ Water hammer pulse
- Wide pulse pressure (large difference between systolic and diastolic BP)
- Cardiac Dilatation
- Early-Diastolic murmur (often decrescendo in sound)
- Numerous eponymous signs
- De Musset’s sign: Head bobbing with pulse
- Duroziers sign: Murmur heard over femoral arteries
- Quinkes sign: visible pulsing of nail-bed capillaries
Causes:
- Acute AR: IE, aortic dissection, AVR failure, ruptured sinus of valsalva, acute rheumatic fever
- Chronic AR: Bicuspid aortic valve, Marfans syndrome, syphilis (aortitis & AR) & seronegative arthritides (all HLA-B27 associated arthritides).
Investigations:
Bedside: O2 saturations, BP (? wide pulse pressure)
Bloods: FBC, U&E (baseline), CRP & ESR (raised in acute rheumatic fever), blood cultures (if querying IE), HLA-B27 for sero-negative arthritides. VRDL or TRPA (syphilis screen)
Functional: Echocardiogram
Invasive: Angiogram prior to any surgical replacement.
Management:
Conservative management is advised in asymptomatic patients
Valve replacement should be considered in patients with:
- Acute AR which is moderate or severe
- Chronic AR with NYHA class II or higher, breathlessness or angina.
- Asymptomatic severe AR defined by: Significant aortic root dilatation, LV dilatation (LVEDD>70mm, LVESD>50mm) & EF<50%.
Written by Dr Thomas Craven
Resources used to write this document are listed in the references section of this webpage