Aortic Regurgitation

#med #disease #y2023 #cardio

Presentation :

Findings in chronic severe AR include:
- angina, orthopnea, and exertional dyspnea
- widened pulse pressure
- left axis deviation and LVH on ECG
- cardiomegaly and aortic root dilatation and calcification on chest x-ray

Acute severe AR usually is caused by IE or aortic dissection
Chronic severe AR is most commonly associated with dilated ascending aorta from hypertension or primary aortic disease, calcific AS, bicuspid aortic valve, or rheumatic disease

Acute Regurgitation:
- Schedule immediate aortic valve replacement
- Significant acute aortic regurgitation due to aortic dissection is a surgical emergency, requiring aortic dissection repair and aortic valve replacement or repair
Chronic Regurgitation:
- SAVR indicated if:
  - symptoms (typically, dyspnea or angina)
  - LV dysfunction (ejection fraction ≤55%) thought to be due to aortic regurgitation
  - severe aortic regurgitation who are undergoing other cardiac surgery.
- SAVR reasonable if:
  - asymptomatic patients with severe AR, normal left ventricular function, and significant LV dilatation (end-systolic dimension >50 mm or indexed end-systolic dimension >25 mm/m2).
- If concomitant hypertension: dihydropyridine calcium channel blockers, ACEs/ARBs