Internal Medicine

P1: SBT

0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8

Aortic Insufficiency (AI) 143

Aortic Insufficiency (AI)................................

JUDITH A. WISNESKI, MD

history & physical

Etiology

■Abnormality in AV leaflets

➣Endocarditis

➣Rheumatic heart disease

➣Collagen vascular disease

➣Congenital bicuspid valve

■Dilation of aortic root

➣Marfan syndrome

➣Annuloaortic ectasia

➣Aortic dissection

➣Syphilis

➣Ankylosing spondylitis

History

■Acute

➣Pulmonary congestion/pulmonary edema

■Chronic

➣Pulmonary congestion (most common)

➣Angina (less common with AI than AS)

➣Syncope (rare)

➣Carotid artery pain (rare)

Signs & Symptoms

■Acute

➣Diastolic murmur

➣Soft S1

■Chronic

➣Diastolic blowing murmur at left sternal border (best appreciated

with patient sitting, leaning forward)

➣Diastolic murmur at right sternal border (suggests very dilated

aortic root)

➣Diastolic murmur at apex (severe AI, Austin-Flint murmur)

➣PMI – hyperdynamic, displaced to left and downward

➣Normal S1 and S2

➣S3 (left ventricular dysfunction)

➣Systolic hypertension