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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 aortic insufficiency

  • 746.4 Congenital insufficiency of aortic valve

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ICD-10-CM Codes

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  • I06.1 Rheumatic aortic insufficiency

  • I35 Nonrheumatic aortic valve disorders

  • Q23.1 Congenital insufficiency of aortic valve

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Preferred Practice Pattern

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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 left ventricle of the heart

  • Sites of aortic regurgitation (AR)2

    • - Valvular

      • Cusp abnormalities

    • - Aortic

      • Dilation

      • Inflammation

      • Tears

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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

  • Electrocardiogram (ECG)3

  • 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 age 50; it becomes most severe after age 80.

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Clinical Findings

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Signs and Symptoms

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Functional Implications

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  • Symptoms depend on degree of valve regurgitation.

  • Patients may be unaware of their reduced cardiovascular capacity.

  • Patients at higher risk of atrial arrhythmias and embolic events.

  • Fatigue from pulmonary edema.

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Possible Contributing Causes

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  • Causes of AR2

    • - Endocarditis

    • - Infectious illness

    • - Ankylosing spondylitis

    • - Marfan syndrome

    • - Ehlers-Danlos syndrome

    • - Aortitis

    • - High blood pressure

    • - Aortic root disease

    • - Dilation of ascending aorta

    • - Syphilis

    • - Reiter syndrome

    • - Trauma

    • - Congenital valve dysfunction

    • - Rheumatic fever

    • - Coronary artery disease

    • - Hyperlipoproteinemia

    • - Hypertension

    • - Diabetes mellitus

    • - Older age

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Differential Diagnosis

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  • Acute coronary syndrome

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