Inadequate closure of the aortic valve during diastole that allows for reverse blood flow through the aortic valve - putting increases load on the left ventricle
Causes/Factors
Acute
- Infective endocarditis
- Ascending aortic dissection
- Chest trauma
Chronic
- Congenital abnormality
- Connective tissue disorders Marfan’s syndrome, Ehlers-Danlos syndrome
- Rheumatic fever
- Takayasu arteritis
- RA
- Systemic Lupus Erythematosus etc
Symptoms
- Exertional dyspnoea
- Orthopnoea
- Paroxysmal nocturnal dyspnea
Signs
- Collapsing pulse (water-hammer)
- Wide pulse pressure
- Displaced, hyperdynamic apex beat
- High pitched early diastolic murmur (heard best in exspiration sat forward)
- Corrigan’s sign (carotid pulsation), de Musset’s sign (head nodding with each beat), Quincke’s sign (capillary pulsations), Duroziez’s sign, Traube’s sign (pistal shot sound over the femoral arteries)
Diagnostic Tests
- Echocardiogram: Diagnostic if seen
- ECG: LVH
- Chest X-ray: Cardiomegaly, dilated ascending aorta, pulmonary oedema
- Cardiac Catheterisation: Assess severity of lesion, anatomy of aortic root, LV function, CAD, other valve disease
Management
Main target of medical therapy is to reduce systolic Essential hypertension
- ACEi helpful
- Echo every 6-12 months to monitor
- For TAVI if enlarged ascending aorta, increasing symptoms, enlarging LV, deteriorating LV function on echo, Infective endocarditis refractory to therapy
- Open heart surgery if not suitable to TAVI
Aim to replace the valve before significant LV dysfunction - poor post-operative prognosis is EF <50%.