Dr. Sharma presents a case of a younger gentleman with dyspnea, palpitations, and chest tightness ultimately diagnosed with aortic regurgitation.
1. What are the indications for an echo?
Diagnostic testing for structural heart disease should be considered in the following patients:
Systolic murmur grade 3/6 or higher
Late or holosystolic murmur
Diastolic or continuous murmur
Murmur + accompanying symptoms
2. How does aortic regurgitation lead to symptoms?
During diastole, blood flows from the aorta back into the LV (diastolic murmur)
This leads to increased LV end diastolic volume and pressure -> compensatory eccentric hypertrophy
Note increased stroke volume and increased aortic systolic pressure with decreased diastolic pressure
Increased LA pressure and pulmonary capillary wedge pressure leads to pulmonary congestion and edema
Epicardial coronary flow shifts from predominantly diastolic to systolic --> reduced coronary flow reserve
3. What are the etiologies of chronic aortic insufficiency?
Rheumatic heart disease
Congenital heart disease, particularly bicuspid aortic valve
Calcific valve disease
Genetic syndromes - Marfan, Ehler's Danlos, osteogenesis imperfecta
Systemic rheum disorders (GCA, takayasu, A.S, R.A, SLE)
Infection - endocarditis or infective aortitis
Aortic dissection/trauma
4. What is the classical murmur of A.I?
High pitched, blowing, early diastolic murmur
Can progress to holodiastolic
Typically at LSB at 3-4th intercostal space
Increases with squatting, decreases with valsalva
5. What do we do with aortic regurg?
Depends on severity - if low severity, monitor for changes in symptoms, and progression of LV systolic function
Valve surgery indicated in symptomatic AR or asymptomatic severe AR with LV systolic dysfunction (EF <50%, consider for End-diastolic dimension >50mm), or undergoing cardiac surgery for other indications
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