Aortic regurgitation

Background

Drawing of aortic regurgitation.

Causes

• Endocarditis
• 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

• Mitral stenosis
• Mitral regurgitation
  • Mitral valve prolapse
• Aortic stenosis
• Aortic regurgitation

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

Acute

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

See Also

• Valvular emergencies
• Heart murmurs

External Links

• emDocs - Acute Valvular Emergencies: Pearls and Pitfalls
• RECAP EM - Diagnosis and Management of Severe Aortic Regurgitation