0071643192.pdf

ACUTEAORTICREGURGITATION

SYMPTOMS

■ Abrupt onset of dyspnea, tachypnea

■ Recent intravenous drug use or fever, if endocarditis

■ Chest pain and presence of risk factors, if aortic dissection

EXAM

■ Pulmonary edema and cardiovascular collapse

■ High-pitched blowing diastolic murmur heard best at left sternal border

■ Normal pulse pressure

DIAGNOSIS

■ Suspect based on history and physical examination

■ CXR: Pulmonary edema

■ Echocardiography confirms diagnosis

TREATMENT

■ Standard treatment for pulmonary edema

■ Nitroprusside for afterload reduction

■ Dobutamine (in addition to nitroprusside) if hypotensive

■ Immediate valve replacement

■ Antibiotics: If endocarditis suspected

■ Avoid:Intra-aortic balloon pump (may worsen regurgitation and is con-

traindicated in aortic dissection)

CHRONICAORTICREGURGITATION

SYMPTOMS

■ Gradual onset of dyspnea on exertion, orthopnea, nocturnal dyspnea

EXAM

■ Congestive heart failure

■ High-pitched blowing diastolic murmur heard best at left sternal border

■ Widened pulse pressure (opposite of AS)

■ Austin Flint murmur(soft mid-diastolic rumble)

■ “Water hammer” pulse(rapid rise and fall)

■ Quincke’s sign(pulsations of nailbeds)

■ Duroziez’s murmur(to-and-fro murmur over femoral artery)

DIAGNOSIS

■ Suspect diagnosis based on history and physical examination.

■ ECG: LVH, left atrial enlargement

■ CXR: Congestive heart failure

■ Echocardiography confirms diagnosis.

TREATMENT

■ Afterload reducers, nitrates, digoxin, and surgical referral for elective valve

replacement

■ Prophylaxis for endocarditis

CARDIOVASCULAR EMERGENCIES

Aggressive afterload reduction

is key to stabilizing the patient

with acute aortic

regurgitation. Intra-aortic

balloon pump is

contraindicated.

Chronic aortic regurgitation is

associated with many CV

exam findings, including CHF,

widened pulse pressure,

pulsations of nailbeds, “water

hammer” pulse, and a to-and-

fro femoral artery murmur.