Aortic regurgitation symptoms: Difference between revisions
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===Chronic Aortic Regurgitation=== | ===Chronic Aortic Regurgitation=== | ||
In chronic AR, patients are usually asymptomatic for many years as the [[stroke volume]] is maintained by increased force of left ventricular contraction secondary to increased left ventricular [[preload]] as explained by [[Frank-Starling mechanism]]. | In chronic AR, patients are usually asymptomatic for many years as the [[stroke volume]] is maintained by increased force of left ventricular contraction secondary to increased left ventricular [[preload]] as explained by [[Frank-Starling mechanism]]. With the progression of AR, the compensatory mechanisms begin to fail causing gradual enlargement of the [[left ventricle]], thereby progressively increasing [[left ventricular end diastolic pressure]] as well as decreasing [[stroke volume]] and [[cardiac output]] leading to [[left ventricular failure]] manifesting as: | ||
With progression of AR, the compensatory mechanisms begin to fail causing gradual enlargement of the [[left ventricle]], thereby progressively increasing [[left ventricular end diastolic pressure]] | |||
*[[Dyspnea on exertion]] | *[[Dyspnea on exertion]] | ||
*[[Orthopnea]] | *[[Orthopnea]] | ||
Revision as of 23:06, 6 January 2015
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Aortic Regurgitation Microchapters |
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Diagnosis |
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Treatment |
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Acute Aortic regurgitation |
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Chronic Aortic regurgitation |
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Special Scenarios |
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Case Studies |
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Aortic regurgitation symptoms On the Web |
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American Roentgen Ray Society Images of Aortic regurgitation symptoms |
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Risk calculators and risk factors for Aortic regurgitation symptoms |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
The symptoms of acute aortic regurgitation (AR) include dyspnea, chest pain (if aortic dissection is the cause of AR), weakness, and symptoms of congestive heart failure. Chronic AR may be asymptomatic for several years until there is a decrease in the stroke volume and cardiac output due to heart failure progression. Symptoms of chronic AR include exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and palpitations.
History and Symptoms
Acute Aortic Regurgitation
In acute severe AR, there is a sudden decrease in the stroke volume and increase in left ventricular end diastolic volume and left ventricular end diastolic pressure which manifests as either sudden and severe dyspnea and/or chest pain (if aortic dissection is the cause of AR). Based on the history and symptoms, the cause of the acute symptoms can be suspected.
Type A Aortic Dissection
- Chest pain of the following characteristics:
- Sudden onset
- Intense
- Tearing and sharp
- Worse with deep breath or cough
- Relieved by sitting upright
- Unexplained syncope
- Previous history of:
Infective Endocarditis
- Persistent fever
- Positive previous blood culture
- High risk factors:
- Pre-existing cardiac abnormality
- Prosthetic valve
- Recent surgical or medical procedures
- Intravenous drug use
- Recent bacterial infection
- History of previous endocarditis
Symptomatic Severe Chronic Aortic Regurgitation
- Previous history of aortic valve disease
Chronic Aortic Regurgitation
In chronic AR, patients are usually asymptomatic for many years as the stroke volume is maintained by increased force of left ventricular contraction secondary to increased left ventricular preload as explained by Frank-Starling mechanism. With the progression of AR, the compensatory mechanisms begin to fail causing gradual enlargement of the left ventricle, thereby progressively increasing left ventricular end diastolic pressure as well as decreasing stroke volume and cardiac output leading to left ventricular failure manifesting as:
- Dyspnea on exertion
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Palpitations (due to compensatory tachycardia)
- Chest pain (if left ventricular end diastolic pressure compromises coronary perfusion)
Once symptoms arise, cardiac function usually worsens more rapidly and mortality may exceed 10% per year.
Pertinent Elements in the Past Medical History
- Cardiac disease:
- Rheumatic fever
- Pulmonary disease
- Trauma
- Syphilis
- Ankylosing spondylitis
- Acromegaly
- Marfan syndrome
- Ehlers-Danlos syndrome
- Giant cell arteritis
- Takayasu's arteritis
- Previous cardiac surgery