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CONDITION/DISORDER SYNONYMS

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  • Aortic insufficiency (AI)

  • Aortic valve regurgitation

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ICD-9-CM CODES

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  • 395.1 Rheumatic AI

  • 746.4 Congenital insufficiency of aortic valve

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ICD-10-CM CODES

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  • I06.1 Rheumatic AI

  • I35 Nonrheumatic aortic valve disorders

  • Q23.1 Congenital insufficiency of aortic valve

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PREFERRED PRACTICE PATTERN

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  • 6D: Impaired Aerobic Capacity/Endurance Associated With Cardiovascular Pump Dysfunction or Failure1

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PATIENT PRESENTATION

A 68-year old male presents with a “pounding” heartbeat when lying down, particularly on his left side. He reports intermittent chest pain that does not seem to be correlated with exercise and frequent episodes of palpitations. Vitals are: Pulse: 96, Respirations: 18, Blood Pressure: 140/50, and SpO2% of 98%. On physical examination, the patient has a “water hammer” pulse in the brachial and radial arteries bilaterally. You notice a head bob occurring with each heart beat and audible systolic and diastolic sounds over the femoral arteries. On auscultation, there is a diastolic murmur in the second right intercostal space.

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KEY FEATURES

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Description
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  • Aortic valve does not close tightly

  • Inadequacy of the aortic valve or the aortic root

  • Leaking of the aortic valve

  • Blood flow in reverse direction: Some blood pumped out of the heart leaks back in

  • Diastolic flow of blood from aorta into left ventricle

  • Acute

    • No compensatory mechanism

    • Occurs suddenly

    • Shortness of breath

    • Pulmonary edema

    • Left-sided heart failure

  • Chronic

    • Heart adapts to increased volume load early in disease process

    • Progresses to left-sided heart failure

    • Fatigue

  • Increased diastolic pressure

  • Increased volume of left ventricle of the heart

  • Sites of aortic regurgitation (AR)2

    • Valvular

      • Cusp abnormalities

    • Aortic

      • Dilation

      • Inflammation

      • Tears

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FIGURE 6-1

Aortic regurgitation. Apical five-chamber Doppler display of aortic valve regurgitation with a pressure half-time of 480 ms. P½t, pressure half-time. (From Pahlm O, Wagner GS. Multimodal Cardiovascular Imaging: Principles and Clinical Applications. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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FIGURE 6-2

Aortic regurgitation. Apical five-chamber color flow image of aortic valve regurgitation. LA, left atrium; LV, left ventricle; RV, right ventricle. (From Pahlm O, Wagner GS. Multimodal Cardiovascular Imaging: Principles and Clinical Applications. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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Essentials of Diagnosis
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  • Stethoscope for auscultation provides a high pitched decrescendo diastolic murmur: Three murmurs can be heard

  • EKG/ECG3

  • Transthoracic echocardiogram

  • Cardiac catheterization

  • Chest X-ray

  • Exercise stress test

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General Considerations
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  • Education on disease management reduces hospitalization

  • Strenuous activity should be limited

  • Signs and symptoms should be monitored

  • Emphasis on wellness and prevention

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Demographics
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  • Chronic form begins after ...

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