Pre PACES Podcast #71 Aortic regurgitation
Oct 8, 2023
Dr. Sarah Verhemel, a cardiology registrar specializing in structural heart disease at Erasmus Medical Centre, discusses the intricacies of aortic regurgitation. She explains the chronic risks of left ventricular dilatation and heart failure, and the emerging TAVI options. Listeners learn about the physiological differences between acute and chronic AR, diagnostic hints to spot it at the bedside, and essential tests to conduct. Dr. Verhemel also touches on surgical indications and the challenge of managing acute severe AR, providing a deep dive into a critical cardiac condition.
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Chronic Versus Acute AR Dynamics
- Chronic aortic regurgitation often progresses slowly with long asymptomatic phases due to LV dilation preserving output.
- Acute AR is an emergency because the undilated ventricle cannot compensate and rapidly develops cardiogenic shock.
Look For Marfanoid Clues And Pulses
- Inspect for marfanoid habitus, long limbs, pectus deformities and dental crowding to clue you into aortopathy causes of AR.
- Check both radial pulses and fingertip capillary pulsations to demonstrate collapsing pulse and capillary pulsation signs.
How To Demonstrate A Collapsing Pulse
- Elicit a collapsing (water-hammer) pulse by moving the arm from low to high while palpating the radial artery.
- Also inspect for head bobbing (de Musset) and capillary pulsations (Quincke) at the fingertips.