Overview
Definition
Incompetency of the aortic valve causing backflow of blood from the aorta into the left ventricle during diastole.
Epidemiology
More common in men. Can present acutely or chronically.
Etiology & Risk Factors
- Acute: Infective endocarditis, Aortic dissection
- Chronic: Bicuspid aortic valve, Rheumatic heart disease, Aortic root dilation (Marfan, Syphilis)
Clinical Symptoms
- Dyspnea on exertion
- Orthopnea
- Palpitations (due to large stroke volume)
- Angina
Clinical Approach
Diagnosis
- Echocardiogram (confirms severity and LV size)
- Auscultation: Early diastolic decrescendo murmur at the left sternal border
- Widened pulse pressure (e.g., 160/60)
- Water-hammer (Corrigan) pulse, Quincke's pulse (capillary pulsations in nail beds)
Management
- Medical: Afterload reduction (ACEI, Nifedipine) for symptom control in chronic AR
- Surgical: Aortic Valve Replacement (AVR) for symptomatic patients or those with declining LV ejection fraction (<50%)
Complications
- Left ventricular volume overload and dilation
- Heart failure