Definition:

Aortic regurgitation (AR) is the abnormal retrograde

flow of blood through the aortic valve during cardiac diastole.

AR may be caused by either valvular or aortic root pathology. Valvular abnormalities that may result in AR include bicuspid aortic valve (the most common congenital cause), rheumatic fever, infective endocarditis, collagen vascular diseases, and degenerative aortic valve disease.

Abnormalities of the ascending aorta, in the absence of valve pathology, may also cause AR, such as may occur with longstanding uncontrolled hypertension, Marfan syndrome, idiopathic aortic dilation, cystic medial necrosis, senile aortic ectasia and dilation, syphilitic aortitis, giant cell arteritis, Takayasu arteritis, ankylosing spondylitis, Whipple disease, and other spondyloarthropathies.

 The flow of blood back into the left

ventricle from the aorta during diastole. It may be caused by inflammatory lesions. Its cause is idiopathic

Assessment
large-volume, 'collapsing' pulse also known as: -Watson's water hammer pulse Corrigan's pulse (rapid upstroke and collapse of the carotid artery pulse) low diastolic and increased pulse pressure de Musset's sign (head nodding in time with the heart beat) Quincke's sign (pulsation of the capillary bed in the nail; named

for Heinrich Quincke) Traube's sign (a 'pistol shot' systolic sound heard over the femoral artery; named for Ludwig Traube) Duroziez's sign (systolic and diastolic murmurs heard over the femoral artery when it is gradually compressed with the stethoscope)

Also, these are usually less detectable in acute cases. Less used signs include: Lighthouse sign (blanching & flushing of forehead) Landolfi's sign(alternating constriction & dilatation of pupil) Becker's sign (pulsations of retinal vessels) Mller's sign(pulsations of uvula) Mayen's sign(diastolic drop of BP>15 mm Hg with arm raised) Rosenbach's sign (pulsatile liver) Gerhardt's sign(enlarged spleen) Hill's sign - a 20 mmHg difference in popliteal and brachial systolic cuff pressures, seen in chronic severe AI. Considered to be an artefact of sphygmomanometric lower limb pressure measurement. Lincoln sign (pulsatile popliteal) Sherman sign (dorsalis pedis pulse is quickly located & unexpectedly prominent in age>75 yr) Ashrafian sign (Pulsatile pseudo-proptosis)

Diagnostic findings
Chest X-ray. With an X-ray of your chest, your doctor can study the size and shape of your heart to determine whether your left ventricle is enlarged a possible sign of damage to the aortic valve. Electrocardiogram (ECG). In this test, patches with wires (electrodes) are attached to your skin to measure the electrical impulses given off by your heart. Impulses are recorded as waves displayed on a monitor or printed on paper. An ECG can provide clues about whether the left ventricle is enlarged, a problem which can occur with aortic valve regurgitation.

Clinical Manifestation
Forceful heartbeat
Pulsation that are visible or palpable

at the carotid or temporal arteries Dyspnea and fatigue Difficulty of breathing

Medical Management
Patient is advised to avoid physical exertion,

competitive sports and isometric exercise The medications usually prescribed first for patients with aortic regurgitation are vasodilators.
Calcium channel blockers (Nifedipine) ACE Inhibitors (Captopril, Enalapril, Lisinopril,

Ramipril) Hydralizine

 Aortic Valvuloplasty- is a procedure in which a thin

tube (catheter) that has a small deflated balloon at the tip is inserted through the skin in the groin area into a blood vessel, and then is threaded up to the opening of the narrowed heart valve. The balloon is inflated, which stretches the valve open. This procedure cures many valve obstructions. It is also called balloon enlargement of a narrowed heart valve.

 Valve Replacement- is a cardiac surgery procedure in

which a patient's failing aortic valve is replaced with mechanical or tissue valve.
Mechanical valves, made from metal, are

durable, but they carry the risk of blood clots forming on or near the valve. If you receive a mechanical aortic valve, you'll need to take an anticoagulant medication, such as warfarin (Coumadin), for life to prevent blood clots. Tissue valves which may come from a pig, cow or human cadaver donor

 Surgery is preferably performed before left ventricular

failure occurs
Surgery is recommended for any patient with left

ventricular hypertrophy, regardless of the presence or absence of symptoms

Patho-physiology