Valvular: Rheumatic (especially if rheumatic mitral disease is present), bicuspid valve, endocarditis. Dilated aortic root: dilatation due to cystic medial necrosis, aortic dissection, ankylosing spondylitis, syphilis. Threefourths of pts are male.
Clinical Manifestations
Exertional dyspnea and awareness of forceful heartbeat, angina pectoris, and signs of LV failure. Wide pulse pressure, water hammer pulse, capillary pulsations (Quincke’s sign), A2 soft or absent, S3 common. Blowing, decrescendo diastolic murmur along left sternal border (along right sternal border with aortic dilatation). May be accompanied by systolic murmur of augmented blood flow.
Laboratory ECG and CXR
LV enlargement.
Echocardiogram
LA enlargement, LV enlargement, high-frequency diastolic fluttering of mitral valve. Failure of coaptation of aortic valve leaflets may be present. Doppler studies useful in detection and quantification of AR.
Aortic Regurgitation TREATMENT
Standard therapy for LV failure (Chap. 133). Vasodilators (long-acting nifedipine or ACE inhibitors) are recommended if hypertension present. Surgical valve replacement should be carried out in pts with severe AR when symptoms develop or in asymptomatic pts with LV dysfunction (LVEF <50%, LV end-systolic volume >55 mL/m2, end-systolic diameter >55 mm, or LV diastolic dimension >75 mm) by imaging studies.
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