Aortic regurgitation overview: Difference between revisions

Jump to navigation Jump to search
mNo edit summary
No edit summary
Line 1: Line 1:
__NOTOC__
{{Aortic insufficiency}}
{{Aortic insufficiency}}


Line 56: Line 57:
==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Cardiology]]
[[Category:Cardiac surgery]]
[[Category:Surgery]]
[[Category:Overview complete]]
[[Category:Template complete]]
[[Category:Valvular heart disease]]
[[Category:Congenital heart disease]]
[[Category:Mature chapter]]


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Revision as of 19:46, 15 August 2012

Aortic Regurgitation Microchapters

Home

Patient Information

Overview

Historical Pesrpective

Pathophysiology

Causes

Stages

Differentiating Aortic Regurgitation from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Cardiac Stress Test

Electrocardiogram

Chest X Ray

Echocardiography

Cardiac MRI

Treatment

Acute Aortic regurgitation

Medical Therapy
Surgery

Chronic Aortic regurgitation

Medical Therapy
Surgery

Precautions and Prophylaxis

Special Scenarios

Pregnancy
Elderly
Young Adults
End-stage Renal Disease

Case Studies

Case #1

Aortic regurgitation overview On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Aortic regurgitation overview

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Aortic regurgitation overview

CDC on Aortic regurgitation overview

Aortic regurgitation overview in the news

Blogs on Aortic regurgitation overview

Directions to Hospitals Treating Aortic regurgitation

Risk calculators and risk factors for Aortic regurgitation overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Varun Kumar, M.B.B.S., Lakshmi Gopalakrishnan, M.B.B.S.

Overview

Aortic Insufficiency refers to the retrograde or backwards flow of blood from the aorta into the left ventricle during diastole[1] [2] [3] [4].

Causes of Aortic Insufficiency

There are two broad causes of aortic insufficiency: diseases of the aortic valve itself and diseases of the aorta.

Aortic valve disease

Aortic root disease

Pathophysiology

Acute Pathophysiology

In acute aortic insufficiency, there is sudden decrease in stroke volume and subsequent increase in left ventricular end diastolic volume thereby causing decrease cardiac output with resultant reflex tachycardia. The sharply rising high left ventricular end diastolic pressure and reflex tachycardia causes profound hypotension and cardiogenic shock. Initially, the rising left ventricle end diastolic pressure causes early closure of mitral valve during diastole thereby preventing backward blood flow. But in severe cases, the rapidly rising left ventricular end diastolic pressure equalizes with the aortic end-diastolic pressure leading to backward flow of blood progressing towards development of pulmonary edema.

Chronic Pathophysiology

In chronic aortic insufficiency, initially the left ventricle remains complaint, thereby compensates for increased left ventricular end diastolic volume by progressive left ventricular dilatation and left ventricular hypertrophy, which maintains normal ratio of wall thickness to the cavity radius, thereby maintaining normal wall stress. Overtime, when the left ventricular hypertrophy fails to keep up with chronic volume overload, end systolic wall stress rises and at this point the left ventricle fails and results in left ventricle decompensation causing reduction in the left ventricular wall compliance with resultant congestive heart failure.

Diagnosis

Electrocardiogram

There is often evidence of left ventricular hypertrophy and left axis deviation.

Chest X Ray

There may be evidence of cardiomegaly.

Echocardiography

Echocardiography provides two-dimensional views of the regurgitant jet and allows measurement of both the velocity and the volume of the jet. In severe aortic insufficiency, the regurgitant jet width is more than 65% of the width of the left ventricular outflow tract (LVOT) and / or there is flow reversal in the descending aorta.

Aortography

A root shot on the aortogram can be used to gauge the amount of aortic insufficiency.

Cardiac MRI

Cardiac MRI can be used to quantify aortic insufficiency.

Treatment

Aortic insufficiency can be treated either medically with vasodilators or surgically with aortic valve replacement, depending on the acuteness of presentation, the symptoms and signs associated with the disease process, and the degree of left ventricular dysfunction.

In general, acute aortic insufficiency with left ventricular dysfunction, symptomatic severe aortic insufficiency, asymptomatic aortic insufficiency with left ventricular dilatation or ejection fraction < 50% should be treated surgically with aortic valve replacement if there are no contraindications.

Chronic aortic insufficiency is managed with vasodilators [7] such as ACE inhibitors , hydralazine or nifidipine to reduce the afterload. Indications for surgery in chronic aortic insufficiency include heart failure with a reduced ejection fraction and increased left ventricular dimensions.

References

  1. Connolly HM, Crary JL, McGoon MD; et al. (1997). "Valvular heart disease associated with fenfluramine-phentermine". N. Engl. J. Med. 337 (9): 581–8. doi:10.1056/NEJM199708283370901. PMID 9271479.
  2. Weissman NJ (2001). "Appetite suppressants and valvular heart disease". Am. J. Med. Sci. 321 (4): 285–91. doi:10.1097/00000441-200104000-00008. PMID 11307869.
  3. 3.0 3.1 Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E (2007). "Dopamine agonists and the risk of cardiac-valve regurgitation". N. Engl. J. Med. 356 (1): 29–38. doi:10.1056/NEJMoa062222. PMID 17202453.
  4. Zanettini R, Antonini A, Gatto G, Gentile R, Tesei S, Pezzoli G (2007). "Valvular heart disease and the use of dopamine agonists for Parkinson's disease". N. Engl. J. Med. 356 (1): 39–46. doi:10.1056/NEJMoa054830. PMID 17202454.
  5. Rothman RB, Baumann MH, Savage JE, Rauser L, McBride A, Hufeisen SJ, Roth BL (2000). "Evidence for possible involvement of 5-HT(2B) receptors in the cardiac valvulopathy associated with fenfluramine and other serotonergic medications". Circulation. 102 (23): 2836–41. PMID 11104741. Retrieved 2011-03-28. Unknown parameter |month= ignored (help)
  6. Waller EA, Kaplan J, Heckman MG (2005). "Valvular heart disease in patients taking pergolide". Mayo Clinic Proceedings. Mayo Clinic. 80 (8): 1016–20. PMID 16092580. Retrieved 2011-03-28. Unknown parameter |month= ignored (help)
  7. Evangelista A, Tornos P, Sambola A, Permanyer-Miralda G, Soler-Soler J (2005). "Long-term vasodilator therapy in patients with severe aortic regurgitation". The New England Journal of Medicine. 353 (13): 1342–9. doi:10.1056/NEJMoa050666. PMID 16192479. Retrieved 2011-03-29. Unknown parameter |month= ignored (help)

Template:WH Template:WS