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Aortic Regurgitation (Examination (Precordium (Murmur (High-pitched EDM,…

- - - - Marfanoid: tall, thin, long arms, high-arched palate
      - Ank spond: cervical kyphosis
    - - Collapsing pulse
      - Wide pulse pressure: e.g. 180/45
    - - Quincke’s: capillary pulsation in nail beds
      - Corrigan’s: visible vigorous carotid pulsation
      - De Musset’s: head nodding
      - Traube’s: pistol-shot sound over femorals
      - Duroziez’s
        
        Systolic murmur over the femoral artery w/ proximal compression.
        
        Diastolic murmur w/ distal compression
      - Mueller’s: systolic pulsations of the uvula
      - Rosenbach’s: systolic pulsations of the liver
  - - - High-pitched EDM
      - LLSE (3rd left IC parasternal)
      - Sitting forward in end-expiration
    - - Ejection systolic flow murmur
      - Austin-Flint murmur
        Rumbling MDM @ apex 2O regurgitant jet
        fluttering the anterior mitral valve
    - - Collapsing pulse
      - Wide pulse pressure
      - LVF
  - - - Bicuspid aortic valve
      - Rheumatic heart disease
      - Autoimmune: Ank spond, RA
      - Connective tissue: Marfan’s, Ehler’s Danlos
    - - Infective endocarditis
      - Type A aortic dissection
- - - - LVH
      - LV strain: lateral T wave inversion
    - - Standard: FBC, U+E, NT-proBNP, lipids, glucose
      - AI disease: ESR, HLA-B27, ANA
    - - Cardiomegaly
      - Pulmonary oedema
    - - Severity
        
        Jet width (>65% of outflow tract = severe)
        
        Regurgitant jet volume
        
        Premature closing of the mitral valve
      - Cause: bicuspid valve, vegetations, dissection
      - LV function
      - Other valve function
  - - - MDT: GP, cardiologist, cardiothoracic surgeon,
        dietician, specialist nurses
      - Optimise CV risk: statins, anti-HTN, DM, anti-plat
      - Monitor: regular f/up and echo
    - - ↓ afterload
        
        ACEi or β-B (esp. carvedilol)
        
        Diuretics
    - - Aim to replace the valve before significant LV dilation and dysfunction.
      - Indications
        
        Symptomatic: NYHA >2
        
        LV dysfunction
        
        Pulse pressure >100mmHg
        
        ECG changes: T inversion in lateral leads
        
        LV enlargement on CXR or EF <50%