Overview
Aortic regurgitation (AR) describes the inadequate closure of the aortic valve leading to the backflow of blood during diastole. It can be due to problems with the aortic valve or the aortic root.
Epidemiology
- Rheumatic fever is the most common cause of AR globally
- Degenerative calcification is more common in the developed world with a peak age of presentation between 40-60 years
Causes
- Causes of valvular disease:
- Rheumatic fever
- Degenerative calcification
- Connective tissue disorders (e.g. rheumatoid arthritis, systemic lupus erythematosus)
- Infective endocarditis
- Causes of aortic root disease:
- Bicuspid aortic valve – the most common congenital cause
- Hypertension
- Marfan syndrome
- Ehlers-Danlos syndrome
Presentation
- Early diastolic murmur that is louder on expiration and sitting forward
- Collapsing pulse
- Soft S1 sound
- Low diastolic pressure
- Wide pule pressure
- Quincke’s sign – nailbed pulsation
- De Musset’s sign – head bobbing
Investigations
Overview
- ECG:
- May show left axis deviation
- Chest x-ray:
- May show cardiomegaly
- Echocardiogram:
- Identifies AR
Differential Diagnoses
Pulmonary regurgitation
- Although the murmur is also diastolic, it is louder in inspiration
- P2 is loud if pulmonary hypertension is present
Management
Overview
Management involves surgery and managing heart failure.
Complications
- Heart failure
- Infective endocarditis
- Sudden cardiac death – relatively rare
Prognosis
- Chronic AR results in left ventricular dilation and heart failure
- Once symptomatic, the mortality rates can be as high as 20% per year
