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)