Aortic regurgitation is backflow of blood from the aorta into the left ventricle (LV) during diastole due to aortic valve not closing properly.
- Most Common Cause: Rheumatic Heart Disease (RHD)
- Mnemonic: "AR = Aorta Returns Blood"
CAUSES OF AORTIC
REGURGITATION
1. Chronic AR
(Develops Slowly)
• Rheumatic Heart Disease (Most Common).
• Aortic Valve Degeneration (Aging, Bicuspid Aortic Valve).
• Marfan Syndrome (Connective Tissue Disorder).
• Aortic Aneurysm/Dilation (Hypertension, Syphilis).
Mnemonic: "R.A.M.A." (Rheumatic, Aneurysm, Marfan, Aging)
2. Acute AR
(Medical Emergency – Develops Suddenly!)
• Infective Endocarditis (Valve Infection).
• Aortic Dissection (Tear in Aorta Wall).
• Trauma (Chest Injury).
Mnemonic: "I.A.T." (Infection, Aortic Tear, Trauma)
PATHOPHYSIOLOGY
OF AR
- Aortic Valve Fails to Close → Blood Leaks Back into LV.
- Left Ventricle Enlarges (Dilation) to Compensate.
- Pulse Pressure Widens (High Systolic, Low Diastolic).
- Late Stage → Heart Failure (LV Fails to Pump Effectively).
Mnemonic: "L.E.W.F." (Leak → Enlarged LV → Wide Pulse → Fails Over Time)
SYMPTOMS OF
AORTIC REGURGITATION
• Palpitations (Due to Forceful LV Contractions).
• Throbbing Neck Pulsations (Corrigan’s Pulse – Water-Hammer Pulse).
• Exertional Dyspnea (Breathlessness on Activity).
• Angina (Chest Pain at Night – Due to Low Diastolic BP).
• Right Heart Failure (Leg Swelling, Liver Congestion – Late Stage).
Mnemonic: "P.T.E.A.R." (Palpitations, Throbbing Pulse, Exertional Dyspnea, Angina, Right HF)
SIGNS &
MURMURS IN AR
- Pulse: Water-Hammer Pulse (Corrigan’s Pulse) – Rapid Upstroke & Collapse.
- Blood Pressure: Wide Pulse Pressure (High Systolic, Low Diastolic).
- Heart Sounds:
- Soft S2 (Aortic Valve Not Closing
Properly).
- Diastolic Murmur – Best Heard at Left
Sternal Border, 3rd ICS.
- Austin Flint Murmur – Mid-Diastolic
Murmur at Apex (Severe AR).
Mnemonic: "C.W.A." (Corrigan’s Pulse, Wide Pulse Pressure, Austin Flint Murmur)
DIAGNOSIS OF
AORTIC REGURGITATION
ECG:
- Left Ventricular Hypertrophy (LVH) due
to Overload.
Chest X-ray:
- Enlarged Heart (LV Dilatation),
Dilated Aortic Root.
Echocardiography (Best Test!)
- Shows Backflow of Blood (Color Doppler
Confirms AR).
Mnemonic: "E.C.E." (ECG, CXR, Echo – Best Test)
TREATMENT OF
AORTIC REGURGITATION
1. MEDICAL
TREATMENT (For Mild-Moderate AR)
- Diuretics (Reduce Lung Congestion & Swelling).
- ACE Inhibitors (Lower Afterload, Reduce LV Stress).
- Beta-Blockers (If Aortic Dissection is Present).
- Antibiotics (Prevent Infective Endocarditis in RHD).
Mnemonic: "D.A.B.A." (Diuretics, ACEI, Beta-Blockers, Antibiotics)
2. SURGICAL
TREATMENT (For Severe AR or Symptoms)
- Aortic Valve Replacement (AVR) – Definitive Treatment!
- Aortic Root Surgery (If Aortic Aneurysm Present).
Mnemonic: "V.R." (Valve Replacement – Required in Severe AR)
COMPLICATIONS OF
AR
• Heart Failure (LV Weakens Over Time).
• Arrhythmias (Atrial Fibrillation – Risk of Stroke).
• Infective Endocarditis (Valve Infection).
• Sudden Death (In Severe Cases).
Mnemonic: "H.A.I.S." (Heart Failure, Arrhythmia, Infection, Sudden Death)
DIFFERENTIAL
DIAGNOSIS (CONDITIONS THAT MIMIC AR)
- Pulmonary Regurgitation (PR): Murmur Increases on Inspiration (Unlike AR).
- Aortic Stenosis (AS): Crescendo-Decrescendo Murmur (AR Has Diastolic Murmur).
- Mitral Regurgitation (MR): Holosystolic Murmur, No Wide Pulse Pressure.
Mnemonic: "P.A.M." (Pulmonary Regurg, Aortic Stenosis, Mitral Regurg)
PREVENTION OF
AORTIC REGURGITATION
- Early Treatment of Rheumatic Fever (Penicillin Prophylaxis).
- Regular Follow-up for Valve Disease.
- Blood Pressure Control (Prevent Aortic Aneurysm).
Mnemonic: "P.R.B." (Penicillin, Regular Check-ups, BP Control)
FINAL REVISION WITH MNEMONICS
- Definition = "AR = Aorta Returns Blood"
- Causes = "R.A.M.A." (Rheumatic, Aneurysm, Marfan, Aging) & "I.A.T." (Infection, Aortic Tear, Trauma)
- Pathophysiology = "L.E.W.F." (Leak → Enlarged LV → Wide Pulse → Fails Over Time)
- Symptoms = "P.T.E.A.R." (Palpitations, Throbbing Pulse, Exertional Dyspnea, Angina, Right HF)
- Signs & Murmurs = "C.W.A." (Corrigan’s Pulse, Wide Pulse Pressure, Austin Flint Murmur)
- Diagnosis = "E.C.E." (ECG, CXR, Echo – Best Test)
- Medical Treatment = "D.A.B.A." (Diuretics, ACEI, Beta-Blockers, Antibiotics)
- Surgical Treatment = "V.R." (Valve Replacement – Required in Severe AR)
- Complications = "H.A.I.S." (Heart Failure, Arrhythmia, Infection, Sudden Death)
- Differential Diagnosis = "P.A.M." (Pulmonary Regurg, Aortic Stenosis, Mitral Regurg)
- Prevention = "P.R.B." (Penicillin, Regular Check-ups, BP Control)
