Fast Five Quiz: Heart Valve Disease

Yasmine S. Ali, MD, MSCI


April 22, 2020

Aortic regurgitation is the diastolic flow of blood from the aorta into the LV. Aortic regurgitation is more common in men than in women. In the cohort from the Framingham study, aortic regurgitation was found in 13% of men and 8.5% of women. The greater prevalence of aortic regurgitation in men may reflect, in part, the preponderance of underlying conditions, such as Marfan syndrome or bicuspid aortic valve, in males.

The typical presentation of severe acute aortic regurgitation includes sudden, severe shortness of breath; rapidly developing heart failure; and chest pain if myocardial perfusion pressure is decreased or an aortic dissection is present. Patients with chronic aortic regurgitation often have a long asymptomatic period that may last for several years.

Cases of acute aortic regurgitation may be fulminant and lead to cardiogenic shock; patients who have congestive heart failure or shock associated with severe aortic regurgitation often appear gravely ill. Other symptoms of acute aortic regurgitation include the following:

  • Tachycardia

  • Peripheral vasoconstriction

  • Cyanosis

  • Pulmonary edema

  • Arterial pulsus alternans; normal LV impulse

Laboratory testing in patients with aortic regurgitation should be guided by the clinical scenario. For example, in patients with aortic regurgitation due to suspected infective endocarditis, peripheral blood counts and cultures may help to clarify the diagnosis and to identify the causative organism. Specific serologic tests may assist in the diagnosis of rheumatologic causes. Laboratory assessment of renal and hepatic function may play an important role in determining a patient's eligibility for certain vasodilator or other drug therapy.

TTE should be performed in all patients with suspected aortic regurgitation, and periodically in patients with confirmed aortic regurgitation of significant severity. Cardiac CT and MRI are not widely used in the management of aortic regurgitation, although support in the literature is increasing for the potential clinical use of these imaging techniques.

In severe acute aortic regurgitation, surgical intervention is usually indicated, but the patient may be supported medically with dobutamine to augment cardiac output and shorten diastole and with sodium nitroprusside to reduce afterload in hypertensive patients.

The current ACC/AHA guidelines provide the following recommendations for vasodilator therapy:

  • Vasodilator therapy is indicated for long-term treatment in patients who have severe chronic aortic regurgitation and symptoms of LV dysfunction but are not candidates for surgery.

  • Vasodilator therapy is reasonable for short-term therapy in patients with severe LV dysfunction and heart failure symptoms, in order to improve their hemodynamic profile before surgery.

  • Vasodilator therapy is acceptable for long-term therapy in asymptomatic patients with severe aortic regurgitation and LV dilation with normal ejection fraction.

Read more about aortic regurgitation.


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