Aortic regurgitation

• Etiology
  • Acute: Infective Endocarditis, Aortic Dissection.
  • Chronic: Bicuspid Valve (most common congenital), Rheumatic, Syphilitic aortitis (root dilation).
• Pathophysiology
  • Acute: LV cannot dilate rapidly → dramatic ↑ in LVEDP → pulmonary edema + cardiogenic shock.
  • Chronic: LV compensates via eccentric hypertrophy (sarcomeres added in series) due to volume overload.
    • ↑ Stroke Volume (SV) to maintain cardiac output → Wide Pulse Pressure (↑ SBP, ↓ DBP).
• Murmur & Exam
  • Diastolic hypotension combined with systolic hypertension t
  • Early diastolic decrescendo murmur.
    • Left Sternal Border = Valvular cause.
    • Right Sternal Border = Aortic Root cause.
  • Austin Flint Murmur: Mid-diastolic rumble at apex (regurgitant jet strikes anterior mitral leaflet).
  • Hyperdynamic signs:
    • Water-hammer pulse (bounding).
    • De Musset sign (head bobbing).
    • Quincke pulse (nailbed pulsation).
• Treatment
  • Medical: Afterload reduction (ACE inhibitors, Dihydropyridine CCBs).
    • Avoid Beta-blockers (↑ diastole time = ↑ regurgitation).
  • Surgical: Symptomatic, Acute, or EF < 50%.