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❑ '''Pulses'''
❑ '''Pulses'''
: ❑ [[Corrigan's pulse]]:A rapid upstroke and collapse of the [[carotid artery pulse]]
: ❑ [[Corrigan's pulse]]:A rapid upstroke and collapse of the [[carotid artery pulse]]
{{#ev:youtube|rh7_MnjrOAY|300}}
❑ '''Cardiac auscultation'''
❑ '''Cardiac auscultation'''
: ❑ Early diastolic decrescendo murmur
: ❑ Early diastolic decrescendo murmur
:: ❑ Best heard at the upper left sternal border  
:: ❑ Best heard at the upper left sternal border  
:: ❑ Murmur increases with: sitting forward, [[expiration]], handgrip
:: ❑ Murmur increases with: sitting forward, [[expiration]], handgrip
{{#ev:youtube|HtDzHWNYKQM|300}}
: ❑ An [[S3]] gallop may be present (suggestive of [[left ventricular dysfunction]])  
: ❑ An [[S3]] gallop may be present (suggestive of [[left ventricular dysfunction]])  
: ❑ [[Austin Flint murmur]]: a soft mid-diastolic rumble, best heard at the cardiac apex
: ❑ [[Austin Flint murmur]]: a soft mid-diastolic rumble, best heard at the cardiac apex
{{#ev:youtube|y5CcncRHl38|300}} <br>
: ❑ [[Traube's sign]]: Systolic and diastolic murmurs described as 'pistol shots' heard over the femoral artery when it is gradually compressed
: ❑ [[Traube's sign]]: Systolic and diastolic murmurs described as 'pistol shots' heard over the femoral artery when it is gradually compressed
'''Search for other signs suggestive of [[aortic insufficiency]]''' <br>
'''Search for other signs suggestive of [[aortic insufficiency]]''' <br>
❑ [[Müller's sign]]: systolic pulsations of uvula <br> ❑ [[de Musset's sign]]: head bobbing with each heart beat <ref name="pmid16855259">{{cite journal |author=Williams BR, Steinberg JP |title=Images in clinical medicine. Müller's sign |journal=[[The New England Journal of Medicine]] |volume=355 |issue=3 |pages=e3 |year=2006 |month=July |pmid=16855259 |doi=10.1056/NEJMicm050642 |url=http://dx.doi.org/10.1056/NEJMicm050642 |accessdate=2012-04-15}}</ref>
❑ [[Müller's sign]]: systolic pulsations of uvula <br> ❑ [[de Musset's sign]]: head bobbing with each heart beat <ref name="pmid16855259">{{cite journal |author=Williams BR, Steinberg JP |title=Images in clinical medicine. Müller's sign |journal=[[The New England Journal of Medicine]] |volume=355 |issue=3 |pages=e3 |year=2006 |month=July |pmid=16855259 |doi=10.1056/NEJMicm050642 |url=http://dx.doi.org/10.1056/NEJMicm050642 |accessdate=2012-04-15}}</ref>
{{#ev:youtube|HLMqkHZ-Mvo|300}}
<br> ❑ [[Hill's sign]]: A ≥ 20 mmHg difference in popliteal and brachial systolic cuff pressures, seen in chronic severe AR. Considered to be an artifact of sphygmomanometric lower limb pressure measurement <br> ❑ [[Quincke's sign]]: Pulsation of the [[capillary]] bed in the nail
<br> ❑ [[Hill's sign]]: A ≥ 20 mmHg difference in popliteal and brachial systolic cuff pressures, seen in chronic severe AR. Considered to be an artifact of sphygmomanometric lower limb pressure measurement <br> ❑ [[Quincke's sign]]: Pulsation of the [[capillary]] bed in the nail
        {{#ev:youtube|9m_0RAQDFHM|300|}}
<br> ❑ '''Pulmonary auscultation:'''  search for [[rales]] (seen when [[congestive heart failure]] has developed)</div> }}
<br> ❑ '''Pulmonary auscultation:'''  search for [[rales]] (seen when [[congestive heart failure]] has developed)</div> }}
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Revision as of 13:44, 19 March 2014


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

Aortic insufficiency refers to the retrograde or backward flow of blood from the aorta into the left ventricle during diastole.[1][2][3][4]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Management

Acute aortic insufficiency

Shown below is an algorithm summarizing the approach to acute aortic insufficiency (AI) [6][7]

 
 
 
 
Characterize the symptoms:
❑ Sudden and severe dyspnea
❑ Chest pain
❑ Palpitations
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Inquire about past medical history:
❑ Previously healthy
❑ Cardiac disease:
❑ Hypertension
❑ Bicuspid aortic valve
❑ Rheumatic fever
❑ Pulmonary disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examine the patient:

❑ Vitals

❑ Heart rate: tachycardia may be present to compensate for a reduced stroke volume
❑ Blood pressure: wide pulse pressure (systolic BP - diastolic BP ≥ 60 mmHg)

❑ Pulses

❑ Corrigan's pulse:A rapid upstroke and collapse of the carotid artery pulse

❑ Cardiac auscultation

❑ Early diastolic decrescendo murmur
❑ Best heard at the upper left sternal border
❑ Murmur increases with: sitting forward, expiration, handgrip
❑ An S3 gallop may be present (suggestive of left ventricular dysfunction)
❑ Austin Flint murmur: a soft mid-diastolic rumble, best heard at the cardiac apex
❑ Traube's sign: Systolic and diastolic murmurs described as 'pistol shots' heard over the femoral artery when it is gradually compressed

Search for other signs suggestive of aortic insufficiency
❑ Müller's sign: systolic pulsations of uvula
❑ de Musset's sign: head bobbing with each heart beat [8]
❑ Hill's sign: A ≥ 20 mmHg difference in popliteal and brachial systolic cuff pressures, seen in chronic severe AR. Considered to be an artifact of sphygmomanometric lower limb pressure measurement
❑ Quincke's sign: Pulsation of the capillary bed in the nail


❑ Pulmonary auscultation: search for rales (seen when congestive heart failure has developed)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Order imaging studies:
❑ Order an echocardiography, assess:
❑ Valve morphology
❑ Pressure gradient
❑ Aortic valve area
❑ Ejection fraction
❑ LV wall thickness and motility

❑ Order a CXR

❑ For acute AI, a CXR might be normal
❑ Increase cardiac silhouette (if the etiology is aortic dissection)
❑ Widened mediastinum (if the etiology is aortic root dilation)
❑ Pulmonary congestion (suggestive of HF)

❑ Order a ECG

❑ Might see nonspecific changes of ST and T wave (due to LV enlargement)
❑ If aortic dissection is the cause, the right coronary artery may be compromised and you may see ischemic changes in the territory of the right coronary artery
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ C02 }}}
 
 
 
 
 
{{{ C03 }}}
 
 
 
 
 
 

Chronic aortic insufficiency

Shown below is an algorithm summarizing the approach to chronic aortic insufficiency [6][7]


 
 
 
 
1111
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Do's

❑


Don'ts

❑


References

  1. ↑ Connolly HM, Crary JL, McGoon MD; et al. (1997). "Valvular heart disease associated with fenfluramine-phentermine". N. Engl. J. Med. 337 (9): 581–8. doi:10.1056/NEJM199708283370901. PMID 9271479.
  2. ↑ Weissman NJ (2001). "Appetite suppressants and valvular heart disease". Am. J. Med. Sci. 321 (4): 285–91. doi:10.1097/00000441-200104000-00008. PMID 11307869.
  3. ↑ Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E (2007). "Dopamine agonists and the risk of cardiac-valve regurgitation". N. Engl. J. Med. 356 (1): 29–38. doi:10.1056/NEJMoa062222. PMID 17202453.
  4. ↑ Zanettini R, Antonini A, Gatto G, Gentile R, Tesei S, Pezzoli G (2007). "Valvular heart disease and the use of dopamine agonists for Parkinson's disease". N. Engl. J. Med. 356 (1): 39–46. doi:10.1056/NEJMoa054830. PMID 17202454.
  5. ↑ Nishimura, RA. (2002). "Cardiology patient pages. Aortic valve disease". Circulation. 106 (7): 770–2. PMID 12176943. Unknown parameter |month= ignored (help)
  6. ↑ 6.0 6.1 "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.
  7. ↑ 7.0 7.1 Bonow, R. O.; Carabello, B. A.; Chatterjee, K.; de Leon, A. C.; Faxon, D. P.; Freed, M. D.; Gaasch, W. H.; Lytle, B. W.; Nishimura, R. A.; O'Gara, P. T.; O'Rourke, R. A.; Otto, C. M.; Shah, P. M.; Shanewise, J. S. (2008). "2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–e661. doi:10.1161/CIRCULATIONAHA.108.190748. ISSN 0009-7322.
  8. ↑ Williams BR, Steinberg JP (2006). "Images in clinical medicine. Müller's sign". The New England Journal of Medicine. 355 (3): e3. doi:10.1056/NEJMicm050642. PMID 16855259. Retrieved 2012-04-15. Unknown parameter |month= ignored (help)


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