Aortic insufficiency stages: Difference between revisions
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==Stages== | ==Stages== | ||
Shown below is a table summarizing the stages of aortic regurgitation (AR) according to the 2014 AHA/ACC guidelines for the management of patients with valvular heart disease. <ref>{{Cite web | last = | first = | title = 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary | url = http://circ.ahajournals.org/content/early/2014/02/27/CIR.0000000000000029.full.pdf+html | publisher = | date = | accessdate = 4 March 2014 }}</ref> | Shown below is a table summarizing the stages of [[aortic regurgitation]] (AR) according to the 2014 AHA/ACC guidelines for the management of patients with [[valvular heart disease]]. <ref>{{Cite web | last = | first = | title = 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary | url = http://circ.ahajournals.org/content/early/2014/02/27/CIR.0000000000000029.full.pdf+html | publisher = | date = | accessdate = 4 March 2014 }}</ref> | ||
<span style="font-size:85%">'''Abbreviations:''' '''AR''': aortic regurgitation; '''ERO''': effective regurgitant orifice; '''HF''': heart failure; '''IE''': infective endocarditis; '''LV''': left ventricular; '''LVEF''': left ventricular ejection fraction; '''LVESD''': left ventricular end-systolic dimension; '''LVOT''': left ventricular outflow tract; '''RF''': regurgitant fraction; '''RVol''': regurgitant volume </span> | |||
{| class="wikitable" | {| class="wikitable" | ||
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| Progressive [[AR]] | | Progressive [[AR]] | ||
| ❑ Mild-to-moderate calcification <br> ❑ Rheumatic valve changes | | ❑ Mild-to-moderate calcification <br> ❑ Rheumatic valve changes | ||
<br> ❑ | <br> ❑ Dilatation of aortic sinuses <br> ❑ [[Infective endocarditis]] | ||
| ❑ Mild [[AR]]: | | ❑ Mild [[AR]]: | ||
: ❑ Jet | : ❑ Jet/LVOT <25% | ||
: ❑ [[Vena contracta]] <0.3 cm | : ❑ [[Vena contracta]] <0.3 cm | ||
: ❑ RVol <30 mL/beat; RF <30% | : ❑ RVol <30 mL/beat; RF <30% | ||
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: ❑ [[Aortography|Angiography]] grade 1+ | : ❑ [[Aortography|Angiography]] grade 1+ | ||
<br> ❑ Moderate [[AR]]: | <br> ❑ Moderate [[AR]]: | ||
: ❑ Jet | : ❑ Jet/LVOT: 25%–64% | ||
: ❑ [[Vena contracta]] 0.3–0.6 cm | : ❑ [[Vena contracta]] 0.3–0.6 cm | ||
: ❑ RVol 30–59 mL/beat | : ❑ RVol 30–59 mL/beat | ||
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| C | | C | ||
| Asymptomatic severe [[AR]] | | Asymptomatic severe [[AR]] | ||
| ❑ Calcific aortic valve disease <br> ❑ Rheumatic valve changes | | ❑ Calcific aortic valve disease <br> ❑ Rheumatic valve changes <br> ❑ Bicuspid valve <br> ❑ Dilated aortic sinuses <br> ❑ [[Infective endocarditis]] with abnormal leaflet closure | ||
<br> ❑ Dilated aortic sinuses <br> ❑ [[Infective endocarditis]] with abnormal leaflet closure | |||
| ❑ Severe [[AR]] | | ❑ Severe [[AR]] | ||
: ❑ Jet | : ❑ Jet/LVOT ≥65% | ||
: ❑ [[Vena contracta]] >0.6 cm; | : ❑ [[Vena contracta]] >0.6 cm; | ||
: ❑ Holodiastolic flow reversal in the proximal abdominal aorta | : ❑ Holodiastolic flow reversal in the proximal abdominal aorta | ||
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<br> ❑ Dilated aortic sinuses <br> ❑ [[Infective endocarditis]] with abnormal leaflet closure | <br> ❑ Dilated aortic sinuses <br> ❑ [[Infective endocarditis]] with abnormal leaflet closure | ||
| | ❑ Severe [[AR]] | | | ❑ Severe [[AR]] | ||
: ❑ Jet | : ❑ Jet/LVOT ≥65% | ||
: ❑ [[Vena contracta]] >0.6 cm; | : ❑ [[Vena contracta]] >0.6 cm; | ||
: ❑ Holodiastolic flow reversal in the proximal abdominal aorta | : ❑ Holodiastolic flow reversal in the proximal abdominal aorta | ||
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|} | |} | ||
==References== | ==References== |
Revision as of 18:53, 8 April 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Overview
According to the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease, aortic insufficiency has 4 stages based on the valve's anatomy and hemodynamics and the patients symptoms.
Stages
Shown below is a table summarizing the stages of aortic regurgitation (AR) according to the 2014 AHA/ACC guidelines for the management of patients with valvular heart disease. [1]
Abbreviations: AR: aortic regurgitation; ERO: effective regurgitant orifice; HF: heart failure; IE: infective endocarditis; LV: left ventricular; LVEF: left ventricular ejection fraction; LVESD: left ventricular end-systolic dimension; LVOT: left ventricular outflow tract; RF: regurgitant fraction; RVol: regurgitant volume
STAGE | DEFINITION | VALVE ANATOMY | VALVE HEMODYNAMICS | HEMODYNAMIC CONSEQUENCES | SYMPTOMS |
---|---|---|---|---|---|
A | At risk of AR | ❑ Bicuspid valve ❑ Valve sclerosis ❑ History of rheumatic fever ❑ Infective endocarditis |
❑ None | ❑ None | ❑ None |
B | Progressive AR | ❑ Mild-to-moderate calcification ❑ Rheumatic valve changes
|
❑ Mild AR:
|
❑ Normal LV systolic function ❑ Normal LV volume or mild LV dilation |
❑ None |
C | Asymptomatic severe AR | ❑ Calcific aortic valve disease ❑ Rheumatic valve changes ❑ Bicuspid valve ❑ Dilated aortic sinuses ❑ Infective endocarditis with abnormal leaflet closure |
❑ Severe AR
|
❑ C1: Normal LVEF and mild to moderate LV dilatation ❑ C2: abnormal LV systolic function with decreased LVEF or severe LV dilatation |
❑ None ❑ Exercise testing to confirm symptom status |
D | Symptomatic severe AR | ❑ Calcific aortic valve disease ❑ Rheumatic valve changes
|
❑ Severe AR
|
❑ May occur with normal systolic function or decreased function ❑ Presence of moderate to severe LV dilatation |
❑ Exertional dyspnea ❑ Exertional angina ❑ HF symptoms
|
References
- ↑ "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.