valvular heart disease aortic regurgitation n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Valvular Heart Disease Aortic Regurgitation PowerPoint Presentation
Download Presentation
Valvular Heart Disease Aortic Regurgitation

Loading in 2 Seconds...

play fullscreen
1 / 14

Valvular Heart Disease Aortic Regurgitation - PowerPoint PPT Presentation


  • 316 Views
  • Uploaded on

Valvular Heart Disease Aortic Regurgitation. Aortic Regurgitation. Etiology Physical Examination Assessing Severity Natural History Prognosis Timing of Surgery. Any conditions resulting in incompetent aortic leaflets Congenital Bicuspid valve Aortopathy Cystic medial necrosis

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Valvular Heart Disease Aortic Regurgitation' - libitha


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
valvular heart disease aortic regurgitation

Valvular Heart Disease Aortic Regurgitation

© Continuing Medical Implementation …...bridging the care gap

aortic regurgitation
Aortic Regurgitation
  • Etiology
  • Physical Examination
  • Assessing Severity
  • Natural History
  • Prognosis
  • Timing of Surgery

© Continuing Medical Implementation …...bridging the care gap

aortic regurgitation etiology
Any conditions resulting in incompetent aortic leaflets

Congenital

Bicuspid valve

Aortopathy

Cystic medial necrosis

Collagen disorders (e.g. Marfan’s)

Ehler-Danlos

Osteogenesis imperfecta

Pseudoxanthoma elasticum

Acquired

Rheumatic heart disease

Dilated aorta (e.g. hypertension..)

Degenerative

Connective tissue disorders

E.g. ankylosing spondylitis, rheumatoid arthritis, Reiter’s syndrome, Giant-cell arteritis )

Syphilis (chronic aortitis)

Acute AI: aortic dissection, infective endocarditis, trauma

Aortic Regurgitation:Etiology

© Continuing Medical Implementation …...bridging the care gap

aortic regurgitation symptoms
Aortic Regurgitation:Symptoms
  • Dyspnea, orthopnea, PND
  • Chest pain.
    • Nocturnal angina >> exertional angina
    • ( diastolic aortic pressure and increased LVEDP thus  coronary artery diastolic flow)
  • With extreme reductions in diastolic pressures (e.g. < 40) may see angina

© Continuing Medical Implementation …...bridging the care gap

peripheral signs of severe aortic regurgitation
Quincke’s sign: capillary pulsation

Corrigan’s sign: water hammer pulse

Bisferiens pulse (AS/AR > AR)

De Musset’s sign: systolic head bobbing

Mueller’s sign: systolic pulsation of uvula

Durosier’s sign: femoral retrograde bruits

Traube’s sign: pistol shot femorals

Hill’s sign:BP Lower extremity >BP Upper extremity by

> 20 mm Hg - mild AR

> 40 mm Hg – mod AR

> 60 mm Hg – severe AR

Peripheral Signs of Severe Aortic Regurgitation

© Continuing Medical Implementation …...bridging the care gap

aortic regurgitation physical exam
Aortic Regurgitation: Physical Exam
  • Widened pulse pressure
    • Systolic – diastolic = pulse pressure
  • High pitched, blowing, decrescendo diastolic murmur at LSB
  • Best heard at end-expiration & leaning forward
  • Hands & Knee position

S1S2 S1

© Continuing Medical Implementation …...bridging the care gap

central signs of severe aortic regurgitation
Apex:

Enlarged

Displaced

Hyper-dynamic

Palpable S3

Austin-Flint murmur

Aortic diastolic murmur

length correlates with severity (chronic AR)

in acute AR murmur shortens as Aortic DP=LVEDP

in acute AR - mitral pre-closure

Central Signs of Severe Aortic Regurgitation

© Continuing Medical Implementation …...bridging the care gap

assessing severity of ar
Assessing Severity of AR
  • Assess severity by impact on peripheral signs and LV
    •  peripheral signs =  severity
    •  LV =  severity
    • S3
    • Austin -Flint
    • LVH
    • radiological cardiomegaly

© Continuing Medical Implementation …...bridging the care gap

aortic regurgitation natural history
Aortic Regurgitation: Natural History

Asymptomatic %/Y

  • Normal LV function (~good prognosis)
    • Progression to symptoms or LV dysfunction < 6
    • Progression to asymptomatic LV dysfunction < 3.5
    • 75% 5-year survival
    • Sudden death < 0.2
  • Abnormal LV function
    • Progression to cardiac symptoms 25
  • Symptomatic (Poor prognosis)
    • Mortality > 10

TX: Medical  Surgery BEFORE LV dysfunction

© Continuing Medical Implementation …...bridging the care gap

Bonow RO, et al, JACC. 1998;32:1486.

echo indications for valve replacement in asymptomatic ar mr
Echo Indications for Valve Replacement in Asymptomatic AR & MR

© Continuing Medical Implementation …...bridging the care gap

indication for valve replacement in aortic regurgitation
Indication for Valve Replacement in Aortic Regurgitation
  • ACC/AHA Class I
    • Symptomatic patients with preserved LVF (LVEF >50%)
    • Asymptomatic patients with mild to moderate LV dysfunction (EF 25-49%)
    • Patients undergoing CABG, aortic or other valvular surgery
  • ACC/AHA Class II a
    • Asymptomatic patients with preserved LVEF but severe LV dilatation (EDD>75 mm or ESD > 55mm)

© Continuing Medical Implementation …...bridging the care gap

indication for valve replacement in aortic regurgitation1
Indication for Valve Replacement in Aortic Regurgitation
  • ACC/AHA Class II b
    • Patients with severe LV dysfunction (EF < 25%)
    • Asymptomatic patients with normal systolic func-tion at rest (EF >0.50) and progressi ve LV dilata-tion when the degree of dilatation is moderatelysevere (EDD 70 to 75 mm, ESD 50 to 55 mm).
  • ACC/AHA Class III
    • Asymptomatic patients with normal systolicf unction at rest (EF >0.50) and LV dilatation when the degree of dilatation is not severe (EDD <70 mm, ESD <50 mm).

© Continuing Medical Implementation …...bridging the care gap