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 [1]. 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 [2]. 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 [3] [4].

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 [5]. 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.

• 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]

  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]

  […] of Devices 570 Harnessing Cardiopulmonary Interactions to Improve Circulation and Outcomes After Cardiac Arrest and Other States of Low Blood Pressure 583 EndStage Congestive Heart Failure Ventricular Assist Devices 605 Cell Transplantation for Ischemic [books.google.com]

  Once they occur, the aortic regurgitation symptoms are mostly from congestive heart failure. Left heart failure results in symptoms related to low cardiac output. [healio.com]

• Sepsis

  Inside, you’ll find totally updated coverage of vital topics, such as coagulation and apoptosis in certain critical care illnesses, such as acute lung injury and adult respiratory distress syndrome; sepsis and other serious infectious diseases; specific [books.google.com]

  Acute severe AR may be difficult to recognize clinically and is often erroneously diagnosed as another acute condition such as sepsis, pneumonia, or nonvalvular heart disease. [circ.ahajournals.org]

  Limitations: Factors affecting the significance of pressure half-time values include changes in LV compliance (e.g. chronic AR), LV diastolic pressure (e.g. systolic dysfunction, ischaemia) and aortic diastolic pressure (e.g. sepsis, patent ductus arteriosus [bsecho.org]

• Anemia

  Patients may present with endocarditis (eg, fever, anemia, weight loss, embolic phenomena) because the abnormal aortic valve is predisposed to bacterial seeding. Signs vary by severity and acuity. [merckmanuals.com]

  Bounding pulses can be seen in other conditions causing hyperdynamic circulation such as thyrotoxicosis, pregnancy, fever, and anemia. D. Physical Examination Findings. [clinicaladvisor.com]

• Orthopnea

  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. [2] Features of Heart Failure (HF) Eg: Paroxysmal nocturnal dyspnea, peripheral edema, orthopnea, breathlessness on exertion, angina on exertion. [explainmedicine.com]

  […] related to underlying disease (e.g., 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 [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]

• Tachypnea

  […] 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]

  Other symptoms of acute aortic regurgitation are tachypnea, tachycardia and rapidly progressive pulmonary edema and/or cardiogenic shock. [textbookofcardiology.org]

• Pleural Effusion

  effusion (L>R), tracheal shift, left apical cap, deviated NGT. [lifeinthefastlane.com]

  Distension of the pulmonary arteries and veins in the upper lung fields and pleural effusions indicate elevated pulmonary pressures. Kerley B lines may be observed in severe mitral stenosis. [textbookofcardiology.org]

• Sputum

  Symptoms Related to pulmonary congestion  Dyspnoea  Orthopnea  Dry cough or with frothy sputum Related to reduction in cardiac output  Exertional fatigue  Apathy  Deterioration in intellectual function Related to etiology  Sudden onset chest and [slideshare.net]

• Hepatomegaly

  Clinical presentation of AR • Symptoms of CHF (most common) • Exertional dyspnoea • Orthopnea • PND • Right heart failure (pedal oedema, ascitis, hepatomegaly) • Atrial or ventricular arrhythmias, do occur in patients with aortic regurgitation, OR late [slideshare.net]

  Hepatomegaly, peripheral edema and ascites due to right sided heart failure can be associated with rapid clinical deterioration. Acute mitral regurgitation is associated with sudden pulmonary congestion and edema. [textbookofcardiology.org]

• Pulsatile Liver

  Right-sided heart failure may cause ascites, congestive hepatosplenomegaly, pulsatile liver, pleural effusions, and peripheral edema. With progression of the disease, patients become cachexic, cyanotic and jaundice may be present. [textbookofcardiology.org]

• Heart Disease

  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]

• Chest Pain

  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]

• Diastolic Murmur

  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]

  S 1 is soft because of the elevated left ventricular end diastolic pressure closing the valve prematurely. Murmur in acute AR Soft EDM (early diastolic murmur) is heard in acute AR. [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]

  Auscultation reveals an S3 and a high-pitched, decrescendo early diastolic murmur. Another characteristic diagnostic finding is widened pulse pressure. [amboss.com]

• Heart Murmur

  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]

  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]

  Regurgitation results in turbulence and the generation of characteristic heart murmurs. [cvphysiology.com]

  […] of the feet, legs, or abdomen Uneven, rapid, racing, pounding, or fluttering pulse Weakness that is more likely to occur with activity Signs may include: Heart murmur that can be heard through a stethoscope Very forceful beating of the heart Bobbing of [medlineplus.gov]

• Tachycardia

  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]

  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]

  Physical findings in Chronic AR • Pulse • Rate is normal • Sinus tachycardia in patients with CHF • Collapsing( Corrigan’s or water hammer pulse) • Blood pressure • Low diastolic pressure • Wide pulse pressure 22. [slideshare.net]

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) [6].
• 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 [7].
• 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 [8] [9]. A value of more than 6mm indicates severe disease. This measurement is highly sensitive and specific.

• Pericardial Effusion

  effusion / tamponade HISTORY Chest pain is classically ripping or tearing in nature, that occurs suddenly and is maximal at onset – however, chest pain is not always present! [lifeinthefastlane.com]

  effusions (eg, in aortic dissection), and provide information about prognosis. [merckmanuals.com]

  effusion心膜液 pericarditis 心膜炎 pericardium 心膜 peripheral 末梢［性］　【形】 permeability透過性、浸透性 phonocardiogram (PCG)心音図 plateau phaceプラトー相 positron emission tomography (PET)ポジトロン放射計断層撮影[法] potential（１）潜在性　【形】　（２）電位 precordial pain前胸[部]痛 preload前負荷 premature beat [tokyo-med.ac.jp]

• Pleural Effusion

  effusion (L>R), tracheal shift, left apical cap, deviated NGT. [lifeinthefastlane.com]

  Distension of the pulmonary arteries and veins in the upper lung fields and pleural effusions indicate elevated pulmonary pressures. Kerley B lines may be observed in severe mitral stenosis. [textbookofcardiology.org]

Recognition and treatment of the most usual causes of acute aortic regurgitation have been described and the emphasis placed on early surgical treatment in the appropriate patient. [ncbi.nlm.nih.gov]

guidelines, discoveries in your fields of interest; be notified You are informed about innovative treatments, techniques and innovations in medicine This video is limited to doctors and other health professionals. [medtube.net]

Apply today's best medical and surgical approaches with comprehensive, expert guidance on today's full range of clinical heart disease treatments. [books.google.com]

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. [symptoma.com]

However, the prognosis for those with severe AR and HF is considerably poorer. [merckmanuals.com]

[…] valvular regurge; aortic valvular regurge; Aortic Valvular Regurge; aortic regurgitation Overview Pathophysiology Causes Differentiating Aortic Insufficiency from other Diseases Epidemiology and Demographics Risk Factors Natural History, Complications and Prognosis [wikidoc.org]

Prognosis and Patient Counseling. Prognosis The long-term prognosis of chronic AR depends on the severity of the regurgitation and the presence of left ventricular dysfunction. [clinicaladvisor.com]

Once your aortic valve is repaired, your prognosis is generally good. However, you’ll always need to guard against and respond quickly to any type of infections that could spread to your heart. [healthline.com]

It has a number of etiologies, including infective and iatrogenic ones. This condition is more common in males. [symptoma.com]

Difference between acute AR and chronic AR Acute AR etiology 2. Infective endocarditis Features of acute AR 1. Pulse rate à Tachycardia 2. Increased chance for hypotension 3. There won’t be cardiomegaly 4. [notes.medicosnotes.com]

Regarding etiology, structural abnormalities, such as a bicuspid aortic valve or prolapse of the AV may be seen. [healio.com]

Rate of progression depends on the etiology of the stenosis. Sometimes can be asymptomatic for 4-5 decades. 2. Usually eventually causes *CHF*. CHF from Aortic regurgitation - signs and symptoms 1. Dyspnea on exertion. 2. [quizlet.com]

Etiology Acute AR Infective endocarditis Aortic dissection ( ascending aorta ) Chest trauma Chronic AR Congenital bicuspid valve : most common cause of AR in young adults and in developed countries Rheumatic heart disease : most common cause of AR in [amboss.com]

[…] aortic regurge; aotic regurgitation; aotic regurge; regurge; regurgitation; valvular regurge; aortic valvular regurge; Aortic Valvular Regurge; aortic regurgitation Overview Pathophysiology Causes Differentiating Aortic Insufficiency from other Diseases Epidemiology [wikidoc.org]

To understand the epidemiology, aetiology, pathophysiology and prognosis of aortic regurgitation 2. To review the qualitative and quantitative echocardiographic methods available to assess severity 3. [bsecho.org]

[…] in the literature in association with AR or aortic valve endocarditis. [18] Connective tissue disorders that can cause significant AR include the following: Floppy aortic valve Aortic valve prolapse Sinus of Valsalva aneurysm Aortic annular fistula Epidemiology [emedicine.medscape.com]

Am Heart J 106: 577 Google Scholar Savage DI), Garrison RJ, Devereux RB et al. (1983) Mitral valve prolapse in the general population. 1: Epidemiologic features: The Framingham Study. [link.springer.com]

Epidemiology Valvular heart diseases are a major burden to society and it is expected that the prevalence will increase. Rheumatic valve disease used to be the most prevalent etiology of valvular cardiac diseases worldwide. [textbookofcardiology.org]

Information relating to the pathophysiology and hemodynamics of acute AR and TAVR-related acute AR, respectively, are collated in this review. [ncbi.nlm.nih.gov]

Aortic Regurgitation Pathophysiology 8. Aortic Regurgitation Pathophysiology 9. [slideshare.net]

[…] regurge; AI; AR; leaky aortic valve; aortic valve prolapse; ar; ai; regurge; aortic regurge; aotic regurgitation; aotic regurge; regurge; regurgitation; valvular regurge; aortic valvular regurge; Aortic Valvular Regurge; aortic regurgitation Overview Pathophysiology [wikidoc.org]

Pathophysiology, clinical recognition and management. Ann Intern Med. 1977 ; 87 :223–232. Crossref Medline Google Scholar 3. Pridie RB, Benham R, Oakley CM. Echocardiography of the mitral valve in aortic valve disease. [circ.ahajournals.org]

[…] most common cause of AR in developing countries Distortion or dilation of the ascending aorta and aortic root Connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome) Tertiary syphilis See also heart valve disease References: [1] [2] Pathophysiology [amboss.com]

Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. ‏ [books.google.com]

Operative intervention earlier rather than later generally improves results and prevents the long-term complications of delayed operations in anatomically complex patients. [ncbi.nlm.nih.gov]

Aortic Valve Stenosis In aortic valve stenosis, a narrowing of the aortic valve prevents it from opening properly. [nyulangone.org]

If you have valve replacement surgery, you may need to take medicines to prevent infection and blood clots around the artificial valve. [healthlinkbc.ca]

1. Obadia JF, Tatou E, David M. Aortic valve regurgitation caused by blunt chest injury. Br Heart J. 1995;74(5):545–547.
2. Hamirani YS, Dietl CA, Voyles W, Peralta M, Begay D, Raizada V. Acute aortic regurgitation. Circulation. 2012;126(9):1121–1126.
3. Stout KK, Verrier ED. Acute valvular regurgitation. Circulation. 2009;119(25):3232-3241.
4. Bekeredjian R, Grayburn PA. Valvular heart disease: aortic regurgitation. Circulation. 2005;112(1):125-134.
5. Babu AN, Kymes SM, Carpenter Fryer SM. Eponyms and the diagnosis of aortic regurgitation: what says the evidence? Ann Intern Med. 2003;138(9):736-742.
6. Lancellotti P, Tribouilloy C, Hagendorff A, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr. 2010;11(3):223-244.
7. 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.
8. Tribouilloy CM, Enriquez-Sarano M, Bailey KR, Seward JB, Tajik AJ. Assessment of severity of aortic regurgitation using the width of the vena contracta: a clinical color Doppler imaging study. Circulation. 2000;102(5):558-564.
9. 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.