Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Aortic insufficiency (AI)Aortic valve regurgitation ++ 395.1 Rheumatic aortic insufficiency746.4 Congenital insufficiency of aortic valve ++ I06.1 Rheumatic aortic insufficiencyI35 Nonrheumatic aortic valve disordersQ23.1 Congenital insufficiency of aortic valve ++ 6D: Impaired aerobic capacity/endurance associated with cardiovascular pump dysfunction or failure1 +++ Description ++ Aortic valve does not close tightlyInadequacy of the aortic valve or the aortic rootLeaking of the aortic valveBlood flow in reverse direction: some blood pumped out of the heart leaks back inDiastolic flow of blood from aorta into left ventricleAcuteNo compensatory mechanismOccurs suddenlyShortness of breathPulmonary edemaLeft-sided heart failureChronicHeart adapts to increased volume load early in disease processProgresses to left-sided heart failureFatigueIncreased diastolic pressureIncreased volume left ventricle of the heartSites of AR2ValvularCusp abnormalitiesAorticDilationInflammationTears +++ Essentials of Diagnosis ++ Stethoscope for auscultation provides a high pitched decrescendo diastolic murmur: three murmurs can be heardEKG/ECG3Transthoracic echocardiogramCardiac catheterizationChest x-rayExercise stress test +++ General Considerations ++ Education on disease management reduces hospitalizationStrenuous activity should be limitedSigns and symptoms should be monitoredEmphasis on wellness and prevention +++ Demographics ++ Chronic form begins after age 50 years; most severe after age 80 years +++ Signs and Symptoms ++ Increased stroke volumeCyanosisHyperdynamic pulses2Third heart sound2Pulmonary edemaDyspnea on exertionNocturnal dyspneaDiaphoresisApical impulse2Angina pectoris2Syncope2Congestive heart failure2Dyspnea on exertionShortness of breath2Anginal chest pain that increases with exerciseOrthopnea2Fatigue, weakness2Shortness of breath2Fainting, dizziness with activityPalpitationsPalpable heaves or thrills over precordiumAudible diastolic murmur in mid-clavicular 5th intercostal space2Swelling of feet and ankles +++ Functional Implications ++ Symptoms depend on degree of valve regurgitationPatients may be unaware of their reduced cardiovascular capacityPatients at higher risk of atrial arrhythmias and embolic eventsFatigue from pulmonary edema +++ Possible Contributing Causes ++ Causes of AR2EndocarditisInfectious illnessAnkylosing spondylitisMarfan syndromeEhler-Danlos syndromeAortitisHigh blood pressureAortic root diseaseDilation of ascending aortaSyphilisReiter’s syndromeTraumaCongenital valve dysfunctionRheumatic feverCoronary artery diseaseHyperlipoproteinemiaHypertensionDiabetes mellitusOlder age +++ Differential Diagnosis ++ Acute coronary syndromeMitral regurgitationAortic stenosisMitral valve stenosis/prolapseMyocardial infarctionShock, hypovolemiaCardiac pump dysfunctionCardiac muscle dysfunction produces slight-to-moderate reduction in cardiac output (CO)Mild-to-moderate activity limitationFunctional capacity of ⩽ 5 to 6 metabolic equivalents (METS)Cardiac pump failureCardiac muscle dysfunction produces moderate-to-severe reduction in COMarked activity limitationFunctional capacity ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.