Acute aortic regurgitation (AAR) is a potentially fatal ailment, that entails the malfunction of the aortic valve. It has a number of etiologies, including infective and iatrogenic ones. This condition is more common in males.
Acute aortic regurgitation (AAR) is a disease where the leaflets of the aortic valve fail to come together and close properly, leading to the backflow of blood. It has several causes, which may be infective, such as bacterial endocarditis, trauma-related, most often blunt trauma to the chest, inflammatory (nonbacterial endocarditis), and aortic dissection . Less commonly, AAR is iatrogenic following cardiac surgery, or due to penetrating chest trauma. In addition, dysfunction of prosthetic valves may be a factor.
AAR may present with clinical features similar to those of heart failure or severe infection . This may make the correct diagnosis of AAR more difficult, however, it is important that it is rightfully diagnosed, as it is an emergency. Furthermore, its prognosis is much poor than the chronic form of the disease  .
The main symptoms of AAR are vascular and in keeping with cardiac failure. Consequently, patients may experience dyspnea, chest pain, and general body weakness. The onset of AAR features such as chest pain and dyspnea is sudden . Signs of the disease commonly include tachycardia, cyanosis, pulsus alternans, crepitations in the lungs indicating pulmonary edema and hypotension and peripheral vasoconstriction leading to cool extremities. Additionally, S1 may be absent, S3 may be present, with a concurrent murmur (Austin Flint murmur). The severity of symptoms varies. Cardiogenic shock may ensue, with multi-system organ failure.
Entire Body System
Congestive Heart Failure
If congestive heart failure can be stabilized by a medical regimen, a course of antibiotic therapy can be administered and elective valve replacement can be performed. [ncbi.nlm.nih.gov]
Heart Failure Ventricular Assist Devices 605 Cell Transplantation for Ischemic Heart Disease 613 Emerging Cardiac Devices and Technologies 631 Index 645 Copyright [books.google.com]
heart failure then develop. [circ.ahajournals.org]
The main one is congestive heart failure. Medicines may not be effective in treating tricuspid regurgitation. Diuretics, or water pills, can help relieve body swelling, or edema, that’s due to congestive heart failure. [webmd.com]
Chronic AR is typically asymptomatic for years followed by progressive exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. [merckmanuals.com]
Another reason is the increased demand of oxygen by the hypertrophied left ventricle.  Features of Heart Failure (HF) Eg: Paroxysmal nocturnal dyspnea, peripheral edema, orthopnea, breathlessness on exertion, angina on exertion. [explainmedicine.com]
fever due to endocarditis, chest pain due to aortic dissection ) Chronic AR May be asymptomatic for up to decades despite progressive LV dilation Palpitations Symptoms of left heart failure Exertional dyspnea Angina Orthopnea Easy fatigability Syncope [amboss.com]
The patient was well until 3 weeks p.t.d. when she developed fever (37.5c), produ-ctive cough and slight back pain, she was hospitalized because of orthopnea. [webview.isho.jp]
Orthopnea - dyspnea when supine. 3. PND - Paroxysmal Nocturnal Dyspnea. Why do you get Nocturnal Angina with Aortic regurgitation? 1. [quizlet.com]
[…] sudden death急死〈頓死〉、突然死 superior vena cava (SVC)上大静脈 supraventricular premature contraction(SVPC)上室期外収縮 supraventricular tachycardia (SVT)上室頻拍 symptom 症状 syncope意識消失、失神 systole［心］収縮［期］ systolic function収縮機能 systolic murmur (SM)収縮期雑音 t tachycardia 頻拍（脈） tachypnea [tokyo-med.ac.jp]
The aspirator to the left is introduced through the leaflet perforation. The aspirator to the right is placed over the ring of the injured leaflet, which is opened in the form of a V, almost obscuring the left and right coronary leaflets. [revespcardiol.org]
Bonow help you to apply all of the latest scientific knowledge and clinical strategies with Valvular Heart Disease, a companion to Braunwald’s Heart Disease. [books.google.com]
A 23-year-old Japanese male with no evidence of previous heart disease was presented with bicuspid aortic valve and a life threatening acute aortic regurgitation due to subacute bacterial endocarditis. [ncbi.nlm.nih.gov]
Consequently, patients may experience dyspnea, chest pain, and general body weakness. The onset of AAR features such as chest pain and dyspnea is sudden. [symptoma.com]
In patients with chest pain and acute aortic regurgitation associated with flail aortic valve, localized intimal tear of aorta should be considered as a possible cause of flail aortic valve. [ncbi.nlm.nih.gov]
Symptoms may include chest pain or pressure, fainting, and shortness of breath. These are signs that you are likely to need surgery. [myhealth.alberta.ca]
Early closure of the mitral valve, weak first heart sound, tall A wave of apexcardiogram, and early diastolic murmur indicated acute aortic regurgitation. [ncbi.nlm.nih.gov]
Murmur in acute AR Soft EDM (early diastolic murmur) is heard in acute AR. It is due to low cardiac output.There is decreased pressure gradient between aorta and left ventricle due to elevated LVEDP. [notes.medicosnotes.com]
A short early diastolic murmur and a short mid-diastolic murmur (terminating with a soft premature mitral valve closure sound) produce a palpable summation gallop. [circ.ahajournals.org]
Subsequent clinical progress was slow, and the patient developed a pronounced aortic diastolic murmur that was not present on admission. [revespcardiol.org]
At CHOP's Cardiac Center, we usually diagnose aortic regurgitation after a primary care doctor detects a heart murmur and refers a child to us. [chop.edu]
murmur that can be heard through a stethoscope Very forceful beating of the heart Bobbing of the head in time with the heartbeat Hard pulses in the arms and legs Low diastolic blood pressure Signs of fluid in the lungs Aortic regurgitation may be seen [medlineplus.gov]
Regurgitation results in turbulence and the generation of characteristic heart murmurs. [cvphysiology.com]
A doctor usually diagnoses a leaky heart valve by: Listening to the heart with a stethoscope for abnormal sounds such as a heart murmur Looking at the results of a heart ultrasound, also called an echocardiogram A person’s description of symptoms along [webmd.com]
Probably a systolic ejection murmur from the large volume. 1. is a low-pitched rumbling heart murmur which is best heard at the cardiac apex. 2.Classically, it is described as being the result of mitral valve leaftlet displacement and turbulent mixing [quizlet.com]
Pulse rate à Tachycardia 2. Increased chance for hypotension 3. There won’t be cardiomegaly 4. [notes.medicosnotes.com]
Signs of the disease commonly include tachycardia, cyanosis, pulsus alternans, crepitations in the lungs indicating pulmonary edema and hypotension and peripheral vasoconstriction leading to cool extremities. [symptoma.com]
System 613 Chapter35D Cardiac Manifestations of Selected Neurologic 626 Chapter35E Cardiovascular Manifestations of Rheumatic 638 Chapter35F The Heart and Infectious Diseases 656 Chapter36 Substance Abuse and the Heart 669 Chapter 63 961 Ventricular Tachycardia [books.google.com]
Diagnostic Testing ECG Tachycardia, LVH, and LAE (more common in chronic AR). New conduction block may suggest an aortic root abscess. CXR Look for pulmonary edema, widened mediastinum, and cardiomegaly. [unboundmedicine.com]
(PSVT)発作性上室性頻拍 paroxysmal ventricular tachycardia (PVT)発作性心室頻拍 patent ductus arteriosus (PDA) 動脈管開存［症］ percardial friction rub心膜摩擦音 percussion 打診［法］、叩打法〈マッサージの一法〉 percutaneous transluminal coronaryangioplasty (PTCA)経皮的冠［状］［動脈］形成［術］ percutaneous transluminal [tokyo-med.ac.jp]
Acute aortic regurgitation is diagnosed clinically, combining history and physical examination findings.
Diagnostic imaging modalities include:
- Transesophageal echocardiography (TEE), which is useful in diagnosing and assessing AAR and visualizing the cause of the defect.
- Transthoracic echocardiogram (TTE) .
- Doppler echocardiography (DE): This is a test used in observing and quantifying regurgitation through the aortic valve. It is the most preferred exam. With DE, it is also possible to assess the anatomy of the root of the aorta and left ventricle.
- Computerized tomography (CT) and magnetic resonance imaging (MRI) have a role in the assessment, as they show the extent of involvement of the aorta. MRI can further provide information on left ventricular function and extent of AAR.
- Radionuclide imaging determines the ejection fraction of the left ventricle.
- Electrocardiogram: This may show electrical abnormalities as well as signs of chamber hypertrophy and enlargement. It is a test that is sensitive and specific (over 90% for both) and is used to aid the timing of surgical intervention .
- Chest X-ray: This may show signs of heart failure, such as pulmonary edema.
- Coronary angiography is important to search for coronary artery disease.
Biochemical studies may be chosen by the physician, according to the patient's clinical features and suspected etiology. These may include full blood count, blood culture, rheumatic makers, and specific organ function tests.
The severity of AAR can be determined by the vena contracta, measured via color Doppler  . A value of more than 6mm indicates severe disease. This measurement is highly sensitive and specific.
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- Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline 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. Circulation. 2014;129(23):2440-2492.
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- Willett DL, Hall SA, Jessen ME, Wait MA, Grayburn PA. Assessment of aortic regurgitation by transesophageal color Doppler imaging of the vena contracta: validation against an intraoperative aortic flow probe. J Am Coll Cardiol. 2001;37(5):1450-1455.