“Abnormal flow of blood back through the aortic valve (fails to fully close)”

Risk Factors
  • Diseases affecting the aortic valve
    • Rheumatic heart disease
    • Infective endocarditis
    • Systemic lupus erythematosus
    • Calcific aortic stenosis
    • Bicuspid aortic valve
  • Diseases resulting in dilation of the aortic root
    • Aortic valve ring
    • Hypertension
    • Marfan’s
    • Syphilis
Aetiology

Blood regurgitates during ventricular relaxation → early diastolic murmur

Pathophysiology
  • ↑ LV volume → LV hypertrophy → LV dysfunction
  • ↑ stroke volume → ↑ systolic BP → myocardial ischaemia
  • ↑ LA pressure → pulmonary congestion
Clinical Presentation
  • Symptoms
    • Gradual onset
    • Mild/absent symptoms
    • LVF – Exertional Dyspnoea, PND, orthopnea
    • Angina
  • Signs
    • Early diastolic murmur → heard on left sternal edge, esp. leaning forward at the end of expiration
    • Collapsing pulse
    • Low diastolic BP
    • Wide pulse pressure
    • Corrigan’s sign – carotid pulsation
    • De Musset’s sign – rhythmic head nodding with heartbeat
    • Quincke’s sign – capillary pulsation in the nail bed
Investigations
  • Bloods:
    • FBC, U+E, glucose, lipids
  • Imaging:
    • Chest X-Ray – Cardiomegaly, pulmonary oedema
    • Echocardiogram – Functional imaging of the heart so volume and blood flow
    • CT, MRI, and coronary angiography  
  • Special:
    • ECG – LV hypertrophy
Management
  • Conservative: n/a
  • Medical:
    • Statins
    • Anti-hypertensives
    • ACE-i and CCB to decrease afterload
  • Surgical:
    • AV replacement

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