AORTIC REGURGITATION


Pathophysiology:

  1. Elevated aortic pulse press. secondary to very large SV
  2. LV systolic pressure and EDP (but < AS)
  3. LV is relatively noncompliantaugmented 'a' wave
  4. Severe regurg may ventr. pressure above atrial pressure before systole beginsearly mitral closure

Heart Sounds: see under "Cardiac Murmurs"

Clinical presentation:

  1. Enlarged LV (mostly dilation) allows high CO
  2. Pulse vol./press. is obvious in large arteries on px
  3. Ventr. hypertrophy and rapidly falling diastolic aortic pressure press. avail. for perfusion of coronary arteries, leading to angina

Diff dx of acute-onset aortic regurg: aortic dissection (pre-op tx with Beta-blockade or afterload reduction), inf. endocarditis

Treatment:

  1. In a study in 95 pts with asymptomatic, severe chronic aortic regurgitation, randomized to nifedipine 20mg BID, enalapril 20mg/d, or no tx, after mean 7y f/u, there were no sig. diffs. in incidence of aortic valve replacement or changes in echocardiographic or hemodynamic variables (NEJM 353:1342, 2005--JW)
  2. Aortic valve replacement