Aortic regurgitation: Difference between revisions

Latest revision as of 11:00, 22 March 2026

Background

Drawing of aortic regurgitation.

Causes

Endocarditis^[1]
Aortic dissection
- Always suspect in acute aortic regurgitation
Blunt chest trauma

Clinical Features

Phonocardiograms of common cardiac murmurs.

Pulmonary edema
Wide pulse pressure
Dyspnea
Hypotension (may progress to cardiogenic shock)
Decrescendo diastolic murmur heard immediately after S2

Differential Diagnosis

Valvular Emergencies

Evaluation

Aortic regurgitation shown on echocardiography: an abnormal stream of blood is visible, regurgitating from the insufficiency aortic valve to the apex of the left ventricle (apical projection, the apex of the heart is at the top of the image).

Severe aortic regurgitation shown on echo with M-Mode through aortic valve.

Subcostal view: pulsed-wave Doppler signal from abdominal aorta: diastolic flow reversal showing severe aortic regurgitation.

Consider the following tests

CXR may be helpful
- May see pulmonary edema with out cardiac enlargement
- Left ventricular hypertrophy and dilated aorta
Transthoracic echo will provide a more definitive diagnosis

Management

Chronic

Acute

Immediate surgical intervention
Reduce afterload
- Nitroprusside
Inotropic support
- Dobutamine
Diuretics and nitrates do not work
Do not use β-blockers (block compensatory tachycardia)

Disposition

Chronic

Acute

External Links

References

↑ Baumbach A, et al. Aortic regurgitation: from mechanisms to management. EuroIntervention. 2024 Sep 2;20(17):e1062-e1075. PMID 39219357

Authors:

[1] Baumbach A, et al. Aortic regurgitation: from mechanisms to management. EuroIntervention. 2024 Sep 2;20(17):e1062-e1075. PMID 39219357

[1]

@@ Line 1: / Line 1: @@
 ==Background==
-*Causes
+[[File:Blausen 0041 AorticValve Regurgitation.png|thumb|Drawing of aortic regurgitation.]]
-**Endocarditis
+===Causes===
-**Aortic dissection
+*[[Endocarditis]]<ref>Baumbach A, et al. Aortic regurgitation: from mechanisms to management. EuroIntervention. 2024 Sep 2;20(17):e1062-e1075. PMID 39219357</ref>
-**Blunt chest trauma
+*[[Aortic dissection]]
+**Always suspect in acute aortic regurgitation
+*Blunt [[chest trauma]]
-===Diagnosis===
+==Clinical Features==
-*Pulmonary edema
+[[File:Phonocardiograms from normal and abnormal heart sounds.svg|thumb|Phonocardiograms of common cardiac murmurs.]]
+*[[Pulmonary edema]]
 *Wide pulse pressure
-*Dyspnea
+*[[Dyspnea]]
-*Hypotension (may progress to cardiogenic shock)
+*[[Hypotension]] (may progress to cardiogenic shock)
-*Diastolic murmur heard immediately after S2
+*Decrescendo diastolic [[murmur]] heard immediately after S2
-*CXR
-**Pulmonary edema w/o cardiac enlargement
-===Treatment===
+==Differential Diagnosis==
+{{Valvular emergencies DDX}}
+==Evaluation==
+[[File:Aortic insufficiency.gif|thumb|Aortic regurgitation shown on echocardiography: an abnormal stream of blood is visible, regurgitating from the insufficiency aortic valve to the apex of the left ventricle (apical projection, the apex of the heart is at the top of the image).]]
+[[File:Severe aortic regurgitation E00181 (CardioNetworks ECHOpedia).jpg|thumb|Severe aortic regurgitation shown on echo with M-Mode through aortic valve.]]
+[[File:Severe aortic regurgitation E00235 (CardioNetworks ECHOpedia).jpg|thumb|Subcostal view: pulsed-wave Doppler signal from abdominal aorta: diastolic flow reversal showing severe aortic regurgitation.]]
+''Consider the following tests''
+*[[CXR]] may be helpful
+**May see pulmonary edema with out cardiac enlargement
+**Left ventricular hypertrophy and dilated aorta
+*[[Cardiac ultrasound|Transthoracic echo]] will provide a more definitive diagnosis
+==Management==
+===Chronic===
+===Acute===
 *Immediate surgical intervention
 *Reduce afterload
-**Nitroprusside
+**[[Nitroprusside]]
-*Diuretics and nitrates don't work
+*Inotropic support
-*Don't use beta blockers (block compensatory tachycardia)
+**[[Dobutamine]]
+*Diuretics and nitrates do ''not'' work
+*Do ''not'' use β-blockers (block compensatory tachycardia)
+==Disposition==
+===Chronic===
+===Acute===
 ==See Also==
-*[[Valvular Emergencies]]
+*[[Valvular emergencies]]
-*[[Heart Murmurs]]
+*[[Heart murmurs]]
-==Source==
+==External Links==
-Tintinalli
+* [http://www.emdocs.net/acute-valvular-emergencies-pearls-pitfalls/ emDocs - Acute Valvular Emergencies: Pearls and Pitfalls]
+* [https://recapem.com/valvular-emergencies-part-2-diagnosis-and-management-of-severe-aortic-regurgitation/ RECAP EM - Diagnosis and Management of Severe Aortic Regurgitation]
-[[Category:Cards]]
+==References==
+<references/>
+[[Category:Cardiology]]