Aortic regurgitation Regurgitation Gastroesophageal Reflux Disease (GERD) (AR) is a cardiac Cardiac Total Anomalous Pulmonary Venous Return (TAPVR) condition characterized by the backflow of blood from the aorta Aorta The main trunk of the systemic arteries. Mediastinum and Great Vessels: Anatomy to the left ventricle during diastole Diastole Post-systolic relaxation of the heart, especially the heart ventricles. Cardiac Cycle. Aortic regurgitation Regurgitation Gastroesophageal Reflux Disease (GERD) is associated with an abnormal aortic valve Aortic valve The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle. Heart: Anatomy and/or aortic root stemming from multiple causes, commonly rheumatic heart disease Rheumatic Heart Disease Cardiac manifestation of systemic rheumatological conditions, such as rheumatic fever. Rheumatic heart disease can involve any part the heart, most often the heart valves and the endocardium. Rheumatic Fever as well as congenital Congenital Chorioretinitis and degenerative valvular disorders. Acute valvular insufficiency, which rapidly progresses to cardiogenic shock Cardiogenic shock Shock resulting from diminution of cardiac output in heart disease. Types of Shock, is an emergency requiring immediate aortic valve Aortic valve The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle. Heart: Anatomy surgery. Chronic AR develops gradually, allowing the left ventricle to adapt to the increased stroke volume Stroke volume The amount of blood pumped out of the heart per beat, not to be confused with cardiac output (volume/time). It is calculated as the difference between the end-diastolic volume and the end-systolic volume. Cardiac Cycle. Thus, echocardiogram Echocardiogram Transposition of the Great Vessels shows left ventricular hypertrophy Hypertrophy General increase in bulk of a part or organ due to cell enlargement and accumulation of fluids and secretions, not due to tumor formation, nor to an increase in the number of cells (hyperplasia). Cellular Adaptation and dilation along with valvular abnormalities. Eventually, congestive heart failure Heart Failure A heterogeneous condition in which the heart is unable to pump out sufficient blood to meet the metabolic need of the body. Heart failure can be caused by structural defects, functional abnormalities (ventricular dysfunction), or a sudden overload beyond its capacity. Chronic heart failure is more common than acute heart failure which results from sudden insult to cardiac function, such as myocardial infarction. Total Anomalous Pulmonary Venous Return (TAPVR) occurs as the left ventricle is unable to handle the hemodynamic overload. Aortic valve replacement Aortic valve replacement Aortic Stenosis is the mainstay of treatment for AR with left ventricular dysfunction.
Last updated: 1 Apr, 2022
Aortic regurgitation Regurgitation Gastroesophageal Reflux Disease (GERD) (AR) or aortic insufficiency:
Symptoms:
Signs:
Phonocardiograms of abnormal
heart sounds
Heart sounds
Heart sounds are brief, transient sounds produced by valve opening and closure and by movement of blood in the heart. They are divided into systolic and diastolic sounds. In most cases, only the first (S1) and second (S2) heart sounds are heard. These are high-frequency sounds and arise from aortic and pulmonary valve closure (S1), as well as mitral and tricuspid valve closure (S2).
Heart Sounds caused by the following
cardiac
Cardiac
Total Anomalous Pulmonary Venous Return (TAPVR) defects:
aortic
regurgitation
Regurgitation
Gastroesophageal Reflux Disease (GERD),
mitral valve prolapse
Mitral valve prolapse
Abnormal protrusion or billowing of one or both of the leaflets of mitral valve into the left atrium during systole. This allows the backflow of blood into left atrium leading to mitral valve insufficiency, systolic murmurs, or cardiac arrhythmia.
Mitral Valve Prolapse, mitral
stenosis
Stenosis
Hypoplastic Left Heart Syndrome (HLHS) (
MS
MS
Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease that leads to demyelination of the nerves in the CNS. Young women are more predominantly affected by this most common demyelinating condition.
Multiple Sclerosis), aortic
stenosis
Stenosis
Hypoplastic Left Heart Syndrome (HLHS) (AS), tricuspid
regurgitation
Regurgitation
Gastroesophageal Reflux Disease (GERD), hypertrophic obstructive
cardiomyopathy
Cardiomyopathy
Cardiomyopathy refers to a group of myocardial diseases associated with structural changes of the heart muscles (myocardium) and impaired systolic and/or diastolic function in the absence of other heart disorders (coronary artery disease, hypertension, valvular disease, and congenital heart disease).
Cardiomyopathy: Overview and Types (HOCM),
atrial septal defect
Atrial Septal Defect
Atrial septal defects (ASDs) are benign acyanotic congenital heart defects characterized by an opening in the interatrial septum that causes blood to flow from the left atrium (LA) to the right atrium (RA) (left-to-right shunt).
Atrial Septal Defect (ASD) (
ASD
ASD
Autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by poor social skills, restricted interests/social interactions, and repetitive/stereotyped behaviors. The condition is termed a “spectrum” because of the wide variability in the severity of symptoms exhibited.
Autism Spectrum Disorder),
ventricular septal defect
Ventricular Septal Defect
Tetralogy of Fallot (VSD), and
patent ductus arteriosus
Patent ductus arteriosus
The ductus arteriosus (DA) allows blood to bypass pulmonary circulation. After birth, the DA remains open for up to 72 hours and then constricts and involutes, becoming the ligamentum arteriosum. Failure of this process to occur results in patent ductus arteriosus (PDA), a condition that causes up to 10% of congenital heart defects.
Patent Ductus Arteriosus (PDA) (
PDA
PDA
The ductus arteriosus (DA) allows blood to bypass pulmonary circulation. After birth, the DA remains open for up to 72 hours and then constricts and involutes, becoming the ligamentum arteriosum. Failure of this process to occur results in patent ductus arteriosus (PDA), a condition that causes up to 10% of congenital heart defects.
Patent Ductus Arteriosus (PDA))
Audio:
This audio clip is an example of aortic regurgitation Regurgitation Gastroesophageal Reflux Disease (GERD). It is characterized by a blowing, decrescendo murmur occurring right after S2 S2 Heart Sounds.
Transesophageal echocardiography Echocardiography Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. Tricuspid Valve Atresia (TVA) showing septal hypertrophy Hypertrophy General increase in bulk of a part or organ due to cell enlargement and accumulation of fluids and secretions, not due to tumor formation, nor to an increase in the number of cells (hyperplasia). Cellular Adaptation (white arrow) and lack of central coaptation of aortic valve Aortic valve The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle. Heart: Anatomy (yellow arrow), resulting in massive aortic regurgitation Regurgitation Gastroesophageal Reflux Disease (GERD). Ao = aorta Aorta The main trunk of the systemic arteries. Mediastinum and Great Vessels: Anatomy. LA = left atrium. LV = left ventricle.
Image: “Valvular involvement in ANCA ANCA Group of systemic vasculitis with a strong association with anca. The disorders are characterized by necrotizing inflammation of small and medium size vessels, with little or no immune-complex deposits in vessel walls. Rapidly Progressive Glomerulonephritis-associated systemic vasculitis Vasculitis Inflammation of any one of the blood vessels, including the arteries; veins; and rest of the vasculature system in the body. Systemic Lupus Erythematosus” by Lacoste C, Mansencal N, Ben M’rad M, Goulon-Goeau C, Cohen P, Guillevin L, Hanslik T. License: CC BY 2.0Electrocardiogram Electrocardiogram An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Electrocardiogram (ECG) of a 70-year-old man with tertiary syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis complicated by aortic regurgitation Regurgitation Gastroesophageal Reflux Disease (GERD). The red arrows show apical-lateral sub-epicardial ischemia Ischemia A hypoperfusion of the blood through an organ or tissue caused by a pathologic constriction or obstruction of its blood vessels, or an absence of blood circulation. Ischemic Cell Damage with inverted T wave T wave Electrocardiogram (ECG).
Image: “Syphilitic aortic insufficiency ECG ECG An electrocardiogram (ECG) is a graphic representation of the electrical activity of the heart plotted against time. Adhesive electrodes are affixed to the skin surface allowing measurement of cardiac impulses from many angles. The ECG provides 3-dimensional information about the conduction system of the heart, the myocardium, and other cardiac structures. Electrocardiogram (ECG)” by Yaméogo AA AA Amyloidosis, Andonaba JB, Nikiéma Z, Zabsonré P. License: CC BY 2.0Syphilitic aortic insufficiency
Chest
X-ray
X-ray
Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. X-ray wavelengths range from 1 pm to 10 nm. Hard x-rays are the higher energy, shorter wavelength x-rays. Soft x-rays or grenz rays are less energetic and longer in wavelength. The short wavelength end of the x-ray spectrum overlaps the gamma rays wavelength range. The distinction between gamma rays and x-rays is based on their radiation source.
Pulmonary Function Tests of a 70-year-old man patient with tertiary
syphilis
Syphilis
Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary.
Syphilis complicated with aortic
regurgitation
Regurgitation
Gastroesophageal Reflux Disease (GERD):
aortic arch
Aortic arch
Mediastinum and Great Vessels: Anatomy (arrow) and
cardiomegaly
Cardiomegaly
Enlargement of the heart, usually indicated by a cardiothoracic ratio above 0. 50. Heart enlargement may involve the right, the left, or both heart ventricles or heart atria. Cardiomegaly is a nonspecific symptom seen in patients with chronic systolic heart failure (heart failure) or several forms of cardiomyopathies.
Ebstein’s Anomaly with widening of the
middle mediastinum
Middle mediastinum
Mediastinum and Great Vessels: Anatomy.
Echocardiography Echocardiography Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic. Tricuspid Valve Atresia (TVA) of a 19-year-old patient. Parasternal long axis Axis The second cervical vertebra. Vertebral Column: Anatomy view of aortic valve Aortic valve The valve between the left ventricle and the ascending aorta which prevents backflow into the left ventricle. Heart: Anatomy in diastole Diastole Post-systolic relaxation of the heart, especially the heart ventricles. Cardiac Cycle (a) shows moderate regurgitation Regurgitation Gastroesophageal Reflux Disease (GERD) (*). Corresponding four-dimensional flow Flow Blood flows through the heart, arteries, capillaries, and veins in a closed, continuous circuit. Flow is the movement of volume per unit of time. Flow is affected by the pressure gradient and the resistance fluid encounters between 2 points. Vascular resistance is the opposition to flow, which is caused primarily by blood friction against vessel walls. Vascular Resistance, Flow, and Mean Arterial Pressure cardiovascular magnetic resonance (4D flow Flow Blood flows through the heart, arteries, capillaries, and veins in a closed, continuous circuit. Flow is the movement of volume per unit of time. Flow is affected by the pressure gradient and the resistance fluid encounters between 2 points. Vascular resistance is the opposition to flow, which is caused primarily by blood friction against vessel walls. Vascular Resistance, Flow, and Mean Arterial Pressure CMR CMR Imaging of the Heart and Great Vessels) images showing the moderate aortic regurgitation Regurgitation Gastroesophageal Reflux Disease (GERD) (b and c). *: regurgitant jet.
Image: “Qualitative grading Grading Methods which attempt to express in replicable terms the level of cell differentiation in neoplasms as increasing anaplasia correlates with the aggressiveness of the neoplasm. Grading, Staging, and Metastasis of aortic regurgitation Regurgitation Gastroesophageal Reflux Disease (GERD)” by Chelu RG, et al AL Amyloidosis. License: CC BY 4.0Differential diagnoses of AR include the following conditions: