Aortic regurgitation

Background

Drawing of aortic regurgitation.

Causes

• Endocarditis
• Aortic dissection
  • Always suspect in acute aortic regurgitation
• Blunt chest trauma

Clinical Features

Phonocardiograms of common cardiac murmurs.

• Pulmonary edema
• Wide pulse pressure
• Dyspnea
• Hypotension (may progress to cardiogenic shock)
• Decrescendo diastolic murmur heard immediately after S2

Differential Diagnosis

Valvular Emergencies

• Mitral stenosis
• Mitral regurgitation
  • Mitral valve prolapse
• Aortic stenosis
• Aortic regurgitation

Evaluation

Severe aortic regurgitation shown on echo with M-Mode through aortic valve.

Subcostal view: pulsed-wave Doppler signal from abdominal aorta: diastolic flow reversal showing severe aortic regurgitation.

Consider the following tests

• CXR may be helpful
  • May see pulmonary edema with out cardiac enlargement
  • Left ventricular hypertrophy and dilated aorta
• Transthoracic echo will provide a more definitive diagnosis

Management

Acute

• Immediate surgical intervention
• Reduce afterload
  • Nitroprusside
• Inotropic support
  • Dobutamine
• Diuretics and nitrates do not work
• Do not use β-blockers (block compensatory tachycardia)

See Also

• Valvular emergencies
• Heart murmurs

External Links

• emDocs - Acute Valvular Emergencies: Pearls and Pitfalls
• RECAP EM - Diagnosis and Management of Severe Aortic Regurgitation