Aortic Regurgitation- Causes, Investigation And Treatment

Depending on how quickly the regurgitation develops, it could be acute or chronic. Depending on where the pathology is located anatomically, it could affect the aorta wall or the leaflets of the aortic valve.

Causes Of Aortic Regurgitation

Acute Aortic Regurgitation 

The left ventricle is experiencing blood backflow, and the left ventricular load is rising. The left ventricular end-diastolic pressure rises sharply. Additionally, the mitral valve closes too soon. The left atrial pressure will rise due to a reduction in the left ventricle's forward filling. Pulmonary oedema and congestion will result from it.The patient may exhibit acute respiratory compromise or rapid hemodynamic worsening.

Chronic Aortic Regurgitation

Once more, the left ventricle's load is increasing. There is a gradual return of blood to the ventricle. Nevertheless, left ventricular dilatation will occur gradually. Thus, eccentric hypertrophy will occur in order to keep the heart's output constant. Dysfunction of the diastolic and systolic phases results in left ventricular failure.

Clinical Features

Patients with chronic conditions do not show any symptoms until left ventricular failure develops. Quincke's sign, pulsatile nail bed; Wide pulse pressure owing to elevated diastolic pressure; Collapsing water hammer pulse.

The following signs and symptoms can be identified: Traube's sign (a pistol-shot-like sound on auscultation of the femoral artery); Corrigan's sign (pulsatile head bobbing); Muller's sign (pulsatile uvula). High-pitched early diastolic murmur;  Apex will be moved laterally, resulting in a hyperdynamic and thrusting appearance. 

Also Read: Zollinger-Ellison Syndrome in Gastrinoma 

Investigation

 Begin with an ECG.  A strain pattern and left ventricular hypertrophy are common.  Left ventricular dilatation-induced cardiomegaly may be shown on a chest x-ray.  Doppler measures the size of the regurgitant jet; echo with color doppler can demonstrate the left ventricular dimension, the diameter of the aortic root, and the severity of AR.
Angiography will be performed on patients who are older than 40.

Treatment

Medicinal: Vasodilators are the first line of treatment; they relieve angina and dyspnea. It will result in less regurgitation and more forward flow.
Reasons to consider surgery: Patients with symptoms, severe regurgitation irrespective of LVEF. Severe AR, LV dysfunction, and LVEF < 50% in asymptomatic individuals. The size of the left ventricle is increasing gradually.

Severe AR and any other reason the patient is having heart surgery.

Severe AR with gradual increase in left ventricular size in asymptomatic individuals with LVEF > 50%.  The preferred procedure is to replace the aortic valve.

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