1. Darrell Sneed, MD FACC Stern Cardiovascular Foundation

2. Disclosure Unfortunately none

3. Aortic Regurgitation Causes Biscuspid AV Infective endocarditis Senile degenerative disease Collagen vascular disease VSD Subaortic stenosis Aortic root dilatation Aortic dissection Must know if etiology is valvular or aortic disease Often associated with MV abnormality also

4. Pathophysiology Acute Abrupt increase in LVEDP with noncompliant LV and high EF and nL LV size Dyspnea &/or pulmonary edema Chronic Excess volume stretches & elongates myocardial fibers which increases wall stress and causes hypertrophy During exercise the volume of AI decreased b/c increased HR causes shortened diastolic period and decreased SVR

5. Clinical Syndrome Dyspnea Widened pulse pressure >100mmHg with DBP <60mmHg Uncomfortable awareness of heart & neck vessels Diastolic thrill at the base of the heart High pitch diastolic, decresendo murmur best @ LSB de Musset sign Quincke sign Marfan characteristics IE stigmata Corrigan pulse Duroziez murmur Austin Flint murmur

6. Evaluation ECG not necessarily unless LVH with chronic AI CXR can hide may hide the proximal portion in the cardiac silhouette TTE TEE MRI Aortography

7. Acute AI Treatment Surgery! Dr. Brad Wolf- cardiothoracic surgery

8. Chronic AI Treatment Long standing overload causes progressive fibrosis and myocyte degeneration with subsequent LV dysfunction Regular follow-up with echo q6- 12 months Dental hygiene and IE prophylaxis LV dysfunction usually develops before symptoms Surgery

9. References Mayo Clinic Cardiology Third Edition J Am Coll Cardiol. 2013;61(7):693-701 J Am Coll Cardiol. 1998;32(5):1486-1582

10. Thank you!