Aortic Insufficiency

                        

Aortic Insufficiency

In rheumatic aortic insufficiency  aortic valve undergoes

            sclerosis

            distortion

            retraction of cusps.

Regurgitation of blood results in - volume overload à dilatation and hypertrophy of the left ventricle.

Combined mitral and aortic insufficiency are more common than aortic involvement alone.

CLINICAL MANIFESTATIONS.

large stroke volume and forceful left ventricular contractions à palpitations.

Excessive sweating and heat intolerance due  to vasodilatation.

Dyspnoea on exertion à orthopnea and pulmonary edema

angina during heavy exercise.

Nocturnal attacks with sweating, tachycardia, chest pain,

The pulse pressure is wide

bounding peripheral pulses.

The systolic blood pressure is elevated,

the diastolic pressure is lowered.

heart is enlarged,

left ventricular apical heave.

There may be a diastolic thrill.

murmur begins immediately with the 2nd heart sound

continues until late in diastole.

murmur is heard over the upper and middle left sternal border with radiation to the apex and to the aortic area.

high-pitched blowing quality

easily audible in full expiration

with the diaphragm of the stethoscope

patient leaning forward.

A systolic ejection murmur is because of the increased stroke volume

apical presystolic murmur (Austin Flint) resembling that of mitral stenosis = result of the large regurgitant aortic flow in diastole that prevents the mitral valve from opening fully.

CXR = enlargement of the left ventricle and aorta.

electrocardiogram

may be normal

signs of left ventricular hypertrophy and strain

with prominent P waves.

The echocardiogram

large left ventricle

diastolic mitral valve flutter caused by regurgitant flow hitting the valve leaflets.

Doppler studies demonstrate the degree of aortic runoff into the left ventricle.

Cardiac catheterization is not usually needed.

PROGNOSIS AND TREATMENT.

Mild and moderate lesions are well tolerated.

aortic insufficiency does not regress.

prophylaxis against the recurrence of acute rheumatic and infective endocarditis.

Surgical intervention (valve replacement) when there are signs of decreasing myocardial performance as manifested by

            increasing left ventricular dimensions on the echocardiogram.

            early symptoms

            ST-T wave changes on the electrocardiogram

            evidence of decreasing left ventricular ejection fraction.