Sandbox/AIRSG

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

Aortic insufficiency refers to the retrograde or backward flow of blood from the aorta into the left ventricle during diastole.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Aortic dissection
• Infective endocarditis

Common Causes

• Rheumatic fever
• Bicuspid aortic valve
• Senile or degenerative calcific aortic valve disease
• Hypertension

Management

Acute aortic insufficiency

Shown below is an algorithm summarizing the approach to acute aortic insufficiency

Characterize the symptoms: ❑ Sudden and severe Dyspnea ❑ Chest pain ❑ Palpitations

Inquire about past medical history: ❑ Previously healthy ❑ Cardiac disease: ❑ Hypertension ❑ Bicuspid aortic valve ❑ Rheumatic fever ❑ Pulmonary disease

Examine the patient: ❑ Heart rate ❑ Pulses ❑ Corrigan's pulse ❑ ❑ Cardiac palpation ❑ Cardiac auscultation ❑ Early diastolic decrescendo murmur ❑ Best heard at the upper left sternal border ❑ Murmur increases with: sitting forward, expiration, handgrip ❑ Traube's sound: ❑ ❑ Muller's sign: systolic pulsations of uvula ❑ de Musset's sign: head bobbing with each heart beat ❑ Hill's sign ❑ Quincke's pulses ❑ Pulmonary auscultation: search for rales (seen when congestive heart failure has developed)

Order imaging studies: ❑ Order an echocardiography, assess: ❑ Valve morphology ❑ Pressure gradient ❑ Aortic valve area ❑ Ejection fraction ❑ LV wall thickness and motility ❑ Order a CXR, look for: ❑ Cardiomegaly ❑ Valve calcification ❑ Dilatation of ascending aorta ❑ Pulmonary congestion ❑ Order a ECG, look for: ❑ LVH ❑ Left atrium enlargement ❑ LBBB ❑ AF (in late disease)

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Chronic aortic insufficiency

Shown below is an algorithm summarizing the approach to chronic aortic insufficiency

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Do's

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Don'ts

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References

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