Aortic regurg is building of each one of these
valvular heart diseases. As we go through
each individual one, everything comes to light
as it has been, hopefully. Once we are done
discussing all valvular heart diseases, it
is important that you keep going back and
reviewing each one because it is easier otherwise
to mix them up and you know exactly what I
am referring to. With aortic regurg, the problem
is blood is coming back from the aorta.
What I would like for you to do is think about the anatomy of
arch of aorta, and it's coming back towards the left ventricle
and when it does so, where is the best place
that you might perhaps hear this murmur again?
It was located in the third intercostal space
and it will be the left parasternal. At least
know that you are moving towards the apex.
If by chance you don't find the third intercostal
space left parasternal as being an answer
choice you don't find that as being an option
on a picture on your screen of a chest, then
you move towards the apex. I hope that is clear.
That is the only way that you will get any
of these questions right without causing further
confusion. Ok. Once you are going to
start bringing about
regurg, completely different when compared to aortic stenosis.
In what respect? In the respect of how the left
ventricle is going to respond technically?
Why am I saying that? Because the response
overall granted whenever that the left ventricle
is undergoing undue pressure either from volume
or from pressure itself the left ventricle
is going to undergo hypertrophy. Is that clear? So whenever
the left ventricle is facing adversity it
is going to try to adapt and rise to the occasion
and with aortic stenosis did they undergo hypertrophy?
Of course, they did. What did it do? It underwent
concentric hypertrophy in which the sarcomere is duplicating
in parallel, in which will eventually may result
in diastole dysfunction but my goodness you
do not want to get your patient to the point
where such heart failure is taking place. Remember
the rule of 5,3 and 2 with aortic stenosis. So, here with aortic
regurg, it is as fact the left ventricle
is facing pathology or adversity with the
volume. So does that mean it will undergo hypertrophy?
Of course, it will but this type of hypertrophy
is one in which the sarcomeres are not going
to duplicate in parallel, they are going
to duplicate in a series and you call this
eccentric type of hypertrophy. Now, what is
interesting about is can you use the same
concept towards congestive heart failure?
Of course, you can. In congestive heart failure,
there is going to be volume overload there as well, but that
has nothing to with aortic regurg per se but
that volume overload may result in hypertrophy,
an eccentric type and what is the state of
your heart? Cardiomegaly, lateral displacement
of your PMI, point of maximum impulse.
Now, with all that said let us take a look
at acute and chronic changes.
In acute changes, all those blood is coming
into the left ventricle and my goodness the
pressure is going to start increasing like
crazy early on. And then, at some point, chronically, take
a look at the size of left ventricle,
it is enlarged. Is it hypertrophy? Yes, it is. Compare.
It is thickened but it's not concentric, this is eccentric. Now how
is the patient going to present? So now we
have all this blood coming back in the left
ventricle but this time, do you have any problem
with opening the aortic valve? No problem.
It just wants to open as freely as that and
so with that free opening of the aortic valve
with no resistance at all basically, you have
increased amounts of blood that is now being
pushed out during systole towards the systemic
circulation. Tell me about some of that systemic
circulations well up into the head. So you might find
bounding pulse in the carotid. Bobbing of the head. Musser's sign.
Might go to the radial, the bounding pulse is there.
You will have a water hammer pulse.
You will have a bunch of those
pulses that we will look at clinically at
the end, understand the concept first and
there are a couple of other things that we
need to walk you through for pathophys and
you have gotten every single concept right.
Let us take a look. Aortic regurg. Abnormality
of backward flow.