Assessing severity of aortic regurgitation

Severity of aortic regurgitation can be assessed with the following.

1.    Murmur duration. Duration of murmur is directly proportional to the severity of AR (>2/3 diastole). In moderate to severe AR mumur is holodiastolic.

2.    Hill Sign

          Mild : < 40 mmHg

          Moderate : 40 – 60 mmHg

          Severe : > 60 mmHg

Hills sign is the difference in blood pressure between the upper limb and lower limb.

3.    Austin flint murmur is heard in severe MR.

4.    Down and out apical impulse.

5.    Marked peripheral signs of AR.

          Heart failure lead to erroneous judgement of severity of AR due to peripheral vasoconstriction. So severely should be reassessed after correction of heart failure.

Causes of Aortic regurgitation

Aortic regurgitation may be caused by the abnormalities of aortic valve or aortic wall.

Causes of AR due to Aortic valve involvement are

1. Rheumatic heart disease
2. Infective endocarditis
3. Congenital bicuspid aortic valve
4. Congenital fenestration of valve 
5. Aortic valve prolapse due to VSD

Causes of AR due to Aortic Wall Involvement are

1. Syphilis
2. Rheumatoid arthritis
3. Ankylosing spondylitis
4. Marfan syndrome 
5. Ehler Danlos syndrome
6. Takayasu arthritis
7. Aortic dissection
8. Systemic hypertension
9. Idiopathic dilatation of aortic wall
10. Annula aortic ectasis

What are the causes of acute AR

1. Infective endocarditis
2. Trauma
3. Dissection 

Valvular

Congenital

• Bicuspid

• Quadricuspid

• Tricuspid

Ankylosing spondylitis

Infective endocarditis

Rheumatic fever

Rheumatoid arthritis

Prosthetic valve malfunction

Fenfluramine and dexfluramine

Libman-Sacks endocarditis

Non-Valvular

Aortic dissection

Marfan's syndrome

Chest trauma

Systemic hypertension

Ehlers-Danlos syndrome

Behcet's disease

Reiter's syndrome

Ankylosing spondylitis

Takayasu's arteritis

Syphilitic aortitis

Aortoannular ectasia