Aortic Regurgitation Classification Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary cause of acute aortic regurgitation?

Aortic dissection

Rheumatic fever

Bacterial endocarditis (correct)

Congenital bicuspid valve

Which factor determines the severity of aortic regurgitation?

Duration of systole

Diastolic pressure gradient between aorta and left ventricle (correct)

Heart rate

Cardiac output

What is the effect of aortic regurgitation on systolic blood pressure?

Increase (correct)

No change

Decrease

Depends on the underlying cause

Which condition may lead to chronic aortic regurgitation?

Congenital bicuspid valve Signup and view all the answers

What does diastolic reflux through the aortic valve lead to?

Left ventricular volume overload Signup and view all the answers

What is the pathophysiological mechanism underlying acute aortic regurgitation?

Bacterial endocarditis Signup and view all the answers

Which treatment modality may reduce afterload and diminish regurgitant volume in chronic aortic regurgitation?

Vasodilator therapy Signup and view all the answers

In which patients should antibiotic prophylaxis be considered prior to certain dental procedures?

At-risk patients, e.g., with prosthetic valves or a history of infective endocarditis Signup and view all the answers

What is the recommended surgical treatment for symptomatic patients with chronic aortic regurgitation?

Aortic valve replacement Signup and view all the answers

In asymptomatic patients with normal LVEF, when should aortic valve replacement surgery or valve repair be undertaken?

If the LV end-diastolic dimension increases to greater than 7 cm Signup and view all the answers

What is the recommended follow-up interval for asymptomatic patients with chronic aortic regurgitation and normal LVEF?

6-month intervals Signup and view all the answers

What is the prognosis of asymptomatic patients with normal LVEF in terms of progression to symptoms or LV dysfunction per year?

< 6% per year Signup and view all the answers

What is the prognosis of asymptomatic patients with decreased EF in terms of progression to symptoms per year?

> 25% per year Signup and view all the answers

What is the mortality rate per year for symptomatic patients with chronic aortic regurgitation?

< 10% per year Signup and view all the answers

What is the LV end-diastolic diameter threshold for deferring aortic valve replacement in asymptomatic patients with chronic aortic regurgitation?

> 7 cm Signup and view all the answers

What is the threshold for considering surgical treatment in asymptomatic patients with chronic aortic regurgitation if the ejection fraction decreases?

< 50% Signup and view all the answers

What is the most common cause of chronic aortic regurgitation in lower-income countries?

Rheumatic heart disease Signup and view all the answers

What peripheral sign is characteristic of chronic aortic regurgitation?

Corrigan pulse Signup and view all the answers

What is the preferred diagnostic tool if aortic dissection is suspected in acute aortic regurgitation?

Angio-CT of the aorta Signup and view all the answers

What is the main objective of cardiac MRI in the evaluation of moderate to severe aortic regurgitation?

Evaluating anatomy and hemodynamics Signup and view all the answers

What is the recommended initial treatment for acute aortic regurgitation in the emergency department?

Administering a positive inotrope and vasodilator Signup and view all the answers

Which sign is associated with moderate to severe chronic aortic regurgitation?

Hill sign Signup and view all the answers

What finding is characteristic of chest radiography in chronic aortic regurgitation?

Prominent aortic root/arch Signup and view all the answers

What is the most significant ECG finding in chronic aortic regurgitation?

$RV6+SV2 > 35 mm$ Signup and view all the answers

What is the characteristic auscultatory finding in chronic aortic regurgitation due to valvular disease?

$High$-pitched, blowing, decrescendo early diastolic murmur Signup and view all the answers

What is the primary diagnostic tool to diagnose aortic regurgitation and assess the severity of disease?

$Transthoracic$ echocardiography Signup and view all the answers

Study Notes

Acute Aortic Regurgitation

The primary cause is usually related to aortic dissection or infective endocarditis.
Diastolic reflux through the aortic valve decreases diastolic pressure and increases stroke volume, altering hemodynamics.

Severity Determinants

Severity is primarily determined by the volume of regurgitant flow and the duration of regurgitation.

Hemodynamic Effects

Systolic blood pressure may rise due to increased stroke volume, while diastolic blood pressure decreases, leading to a widened pulse pressure.

Chronic Aortic Regurgitation Causes

Commonly caused by conditions such as rheumatic heart disease, degenerative valve disease, or aortic root dilation.

Pathophysiological Mechanisms

Acute aortic regurgitation leads to sudden volume overload of the left ventricle.

Treatment Modalities

Medications such as vasodilators can reduce afterload and decrease regurgitant volume in chronic aortic regurgitation.

Antibiotic Prophylaxis

Recommended prior to dental procedures for high-risk patients, especially those with prosthetic heart valves or a history of endocarditis.

Surgical Treatment Recommendations

Symptomatic patients with chronic aortic regurgitation should undergo aortic valve replacement.

Aortic Valve Replacement Timing

In asymptomatic patients with normal left ventricular ejection fraction (LVEF), surgery should be considered when LVEF decreases or if LV dilatation occurs.

Follow-Up Guidelines

Asymptomatic patients with normal LVEF should be followed up annually with echocardiography.

Prognosis for Asymptomatic Patients

Asymptomatic patients with normal LVEF have low annual progression rates to symptoms or left ventricular dysfunction.
In patients with decreased EF, the annual progression to symptoms is higher.

Mortality and Surgical Indicators

Symptomatic patients face a mortality rate of about 10% per year.
A left ventricular end-diastolic diameter (LVEDD) threshold of 60 mm is typically used to consider aortic valve replacement in asymptomatic patients.

Common Causes in Resource-Limited Settings

In lower-income countries, rheumatic fever remains the most common cause of chronic aortic regurgitation.

Peripheral Signs

Characteristic peripheral sign includes a bounding pulse.

Diagnostic Tools

If aortic dissection is suspected, a CT scan is preferred for diagnosis.
Cardiac MRI is used to assess the severity of aortic regurgitation and evaluate left ventricular function.

Emergency Department Treatment

Initial treatment for acute aortic regurgitation often includes intravenous medications to manage hemodynamic stability.

Clinical Signs

Moderate to severe chronic aortic regurgitation is associated with signs such as diastolic murmur.
Chest radiography may reveal left ventricular enlargement and aortic regurgitation.

ECG Findings

The most significant ECG finding includes signs of left ventricular hypertrophy.

Auscultation Findings

Characteristic auscultatory finding is a high-pitched, blowing diastolic murmur.

Primary Diagnostic Tool

Echocardiography is the primary diagnostic tool used to diagnose aortic regurgitation and assess its severity.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge of aortic regurgitation classification, including acute AR primarily caused by bacterial endocarditis or aortic dissection, chronic AR due to congenital bicuspid valve or rheumatic fever, and the clinical implications of acute AR.