Table of Contents
Aortic regurgitation
Aortic regurgitation results in regurgitation of blood from the aorta back into the left ventricle during diastole. This results in increased left ventricular end-diastolic volume.
- Character: Early diastolic (sounds like a breath)
- Best heard: upper right sternal edge (or lower left sternal edge sitting forwards); loudest on expiration
- Radiation: none
- Symptoms:
- Signs:
- Collapsing pulse
- Wide pulse pressure
- Very displaced thrusting apex (volume-loaded)
- Backflow signs:
- Corrigan’s (visible carotid pulsation)
- de Musset’s (head-nodding pulse)
- Quincke’s (red-coloured pulsation in nails)
- ±Austin Flint murmur (apical diastolic rumble)
Causes of… Aortic regurgitation
Acute causes
- Infective endocarditis
- Aortic dissection
Chronic causes
- Connective tissue disorders (e.g. Marfan syndrome, ankylosing spondylitis)
- Rheumatic heart disease
- Luetic heart disease (syphilis)
- Congenital/bicuspid aortic valve
- Longstanding hypertension
Mitral stenosis
Mitral stenosis causes increased resistance between left atrium and left ventricle. This results in high left atrial pressure and subsequent pulmonary hypertension.
- Character: low rumbling mid-diastolic with opening snap
- Best heard: apex in left lateral position; loudest on expiration using bell of stethoscope
- Radiation: none
- Symptoms:
- Dyspnoea
- Fatigue
- Haemoptysis
- Chest pain
- Signs:
- Malar flush (due to low cardiac output)
- AF
- Tapping apex (palpable S1)
- Loud S1
- Signs of pulmonary hypertension (RV heave, loud P2)
Causes of… Mitral stenosis
- Rheumatic heart disease
- Others causes rare (e.g. congenital, carcinoid)
