Aortic regurgitation

Aortic regurgitation

Aortic Regurgitation

Aortic valve involv in RHD results in AR

**Hemodynamics:-
-Backward leak 4m aorta into left ventricle during diastole. -Dis increases volume of blood reaching d left ventricle. Left ventricle increases in size 2 accomodate d extra volume. -So dat forward flow impaired.
-Peripheral pulse pressure is wide becoz of increased systolic &



lowred diastolic pressure. Signs of wide pulse pressure in d form of exaggerated arterial & arteriolar pulsations.

**Clinical picture
#Commonly in males
#Main symptom is palpitation
#Wide pulse pressure
#Prominent carotid pulsations(Corrigan's sign)
#Visible arterial pulsations over extremity vessels(Dancing peripheral arteries)
#Corrigan pulse/Water hammer pulse
#Nodding of head wid each systole(de Musset's sign) due 2 sudden filling of carotid vessels in severe AR
#Exaggeration of d systolic pressure difference betwen brachial & femoral arteries(Hill's sign)
#If stethoscope is put over brachial or d femoral artery widout applying any pressure(Pistol shot sounds)
#A systolic murmur heard over d femoral artery when it is compressed proximally & a diastolic murmur when it is compressed distally(Duroziez sign)
#Precordium shows cardiac enlargement wid apex displaced downward & outward
#First heart sound(S1) may b soft
#A2 of 2nd heart sound may b audible or may b masked by d regurgitant diastolic murmur
#Early diastolic mumur of AR- high pitched, early diastolic, decrescendo murmur
#ECG-increase in ventricular voltages wid deep "S" waves in V1 & tall "R" waves in V6

**D/D:-
1)Conditions asso wid wide pulse pressure like PDA, AV fistulae, VSD wid AR, anaemia, thyrotoxicosis
2)Conditions asso wid non-rheumatic regurgitant diastolic murmur like PR, AR wid VSD, ruptured sinus of Valsalva

**Management
-Mild 2 moderate AR is well tolerated for yrs.
-Significant AR, if asso wid either angina like chest pain or signs of LVF, can only b managed surgicly
-Surgicl- Aortic valve replacement either by homograft or a prosthetic valve
-Operative treatment only in patients of ventri failure or angina
-Bfore a paediatric pt sent for valve replacement surgery 1 shud consider-
1) rheumatic activity
2) progressive deterioration
3) cardiac status of patient