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  • Aortic insufficiency (AI)
  • Aortic valve regurgitation

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  • 395.1 Rheumatic aortic insufficiency
  • 746.4 Congenital insufficiency of aortic valve

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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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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 AR2
    • 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
  • 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 age 50 years; most severe after age 80 years

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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
    • Ehler-Danlos syndrome
    • Aortitis
    • High blood pressure
    • Aortic root disease
    • Dilation of ascending aorta
    • Syphilis
    • Reiter’s 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
  • Mitral regurgitation
  • Aortic stenosis
  • Mitral valve stenosis/prolapse
  • Myocardial infarction
  • Shock, hypovolemia
  • Cardiac pump dysfunction
    • Cardiac muscle dysfunction produces slight-to-moderate reduction in cardiac output (CO)
    • Mild-to-moderate activity limitation
    • Functional capacity of ⩽ 5 to 6 metabolic equivalents (METS)
  • Cardiac pump failure
    • Cardiac muscle dysfunction produces moderate-to-severe reduction in CO
    • Marked activity limitation
    • Functional capacity of ⩽ 4 to 5 METS

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