Internal Medicine

P1: SBT

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

146 Aortic Insufficiency (AI) Aortitis

Prognosis

■Degree of LV dysfunction prior to AVR major determinant of long-

term prognosis (end-systolic dimension > 55 mm, worse progno-

sis)

Aortitis............................................

KENDRICK A. SHUNK, MD, PhD

history & physical

History

■Asian, female (Takayasu’s arteritis)

■Prior untreated Syphilis

■Rheumatologic disease (ankylosing spondylitis as prototype, others

as well)

■Black, female (Giant cell arteritis)

Signs & Symptoms

■Fever, anorexia, malaise, weight loss, night sweats, arthralgias, fa-

tigue, pleuritic pain, localized pain over other affected arteries,

polymyalgia rheumatica, headaches, claudication, paresthesias,

TIA, tender arteries, unequal pulses

tests

■Basic blood tests:

➣Often elevated: ESR, CRP, WBC, IgG, IgM, C3 and C4 comple-

ment, alpha2 globulin (Takayasu’s, Giant cell, rheumatolgic)

➣Anemia of chronic disease often present

➣Occasionally present: rheumatoid factor, ANA (Takayasu’s,

rheumatologic)

➣Luetic: serology negative in 15–30% (e.g. VDRL), fluorescent tre-

ponemal (FTA-ABS) almost always positive.

■Specific diagnostic tests: Takayasu’s criteria

➣Age < 40 at diagnosis or onset

➣andeither 2 major, 1 major+2 minor, or 4 minor criteria

Major (2): left mid subclavian stenosis, right mid subclavian

stenosis

Minor (9): high ESR, Carotid tenderness, HTN, aortic regurgita-

tion or aortoannular ectasia, pulmonary artery lesion, left mid

common carotid lesion, distal brachiocephalic trunk lesion,

descending thoracic aorta lesion, abdominal aorta lesion