Aortic Insufficiency

volume overload.

a preload issue

• 1.) Rheumatic
• 2.) Congenital- bicuspid AV
• 3.) Infective endocarditis
• 4.) Aortic root dilatation
• 5.) Aortic

4-5

a congenital abnormality when the AV has two leaflets and one is usually larger than the other.

• 1.) vertical from 12 to 6 oclock
• 2.) horizontally from 9 to 3 oclock

raphe

rudimentary cusp

2%

No

• 1.) Eccentric closure in diastole in PLAX
• 2.) Best view too view the cusps is SAX

Eccentric closure line

• 1.) AI
• 2.) AS

• 1.) AS
• 2.) AI
• 3.) Infective endocarditis
• 4.) High association of coarctation of aorta

Descending AO at Isthmus

Staph or Strep bacteria can get into the bloodstream and vegetations will form on the valves of the heart and eat away at them.

Drug addiction and using dirty needles.

Any aortic root measuring over 3.7 cm is dilated.

• 1.) Marfan's syndrome
• 2.) Aortic aneurysm
• 3.) Dissecting aneurysm
• 4.) Aneurysm of sinuses of valsalva
• 5.) Hypertension
• 6.) Atherosclerosis

the leaflets fall backward into the LV

• 1.) Infective endocarditis
• 2.) Dissecting aneurysm
• 3.) Rupture or prolapse of aortic leaflets

• 1.) The LV has an increase in volume and workload without time to hypertrophy or dilate.
• 2.) So will have an increase in pressure overload.
• 3.) Will have a very high LV end diastolic pressure which will cause...
• 4) Murmur will be difficult or impossible to hear.

endocarditis eating away at the leaflets.

It follows the direction of blood flow.

• Leaflets point into LV during diastole.
• Leaflets point into AO during systole.

high frequency flutter on the valve in diastole.

• 1.) precordial pain (sharp, sudden chest pain)
• 2.) occasional dizziness
• 3.) syncope
• 4.) exertional or paroxysmal dyspnea (shortness of breath with exertion)
• 5.) high pitched, blowing, decrescendo diastolic murmur 
• 6.) possible Austin Flint murmur with severe AI

High pitched, blowing, decrescendo, diastolic murmur

severe AI

low pitched, mid diastolic rumble

best heard at apex

cardiac cath

a volume overload

preload

Look at the EKG.

AS during systole

AI during diastole

Volume overload problems eventually led to pressure overload problems.

• 1.) Increase in LV volume = preload
• 2.) Increase in SV = LVVO
• 3.) Increase in LV dilation = cardiac failure
• 4.) Increase in LV pressure

• 1.) Initially LVVO
• 2.) Enlarged left ventricle
• 3.) Hyperdynamic LV
• 4.) Later stage LVH
• 5.) Ultimately LV failure
• 6.) LA remains normal unless severe AI
• 7.) May cause cerebral insufficiency= dizziness
• 8.) Headaches (due to dilated aorta and increased stroke volume)

• 1.) When the end-diastolic LV diameter exceeds 7.0 cm or end-systolic LV measurement exceeds 5.0 cm
• 2.) Fractional shortening drops below 30%
• 3.) Patient is extremely symptomatic

• 1.) the steeper the slope the more severe
• 2.) the intensity of the waveform (increase in spectral boardening)
• 3.) the lower the Pressure half time the more severe

decreases the pressure half time

PLAX  = blue jet

PSAX = should be red but is probably going to be blue

• Mild = > 500 ms
• Moderate, mod to severe = 500 - 200 ms
• Severe = < 200 ms

• 1.) PLAX
• 2.) PSAX
• 3.) 5 chamber
• 4.) 3 chamber
• 5.) suprasternal views
• 6.) subcostal

• 1.) Width of the jet
• 2.) the color of the jet
• 3.) how far back into the LV
• 4.) if it causes the mitral valve to close early -hits the ALMV

the diameter of the jet

tip back and forth in and out of the valve to get all the AI

• 1.) How wide the jet?
• 2.) How far back into the LV?
• 3.) Do pressure half time here!

in apical 5 chamber

3 chamber

Look at the Descending AO to see if there is a reversal of flow during diastole.  (abnormal- red flow)

• 1.) thickened aortic leaflets
• 2.) dialted Ao Root
• 3.) Lack of leaflet coaptation
• 4.) Aortic Valve prolapse
• 5.) Flail aortic leaflets
• 6.) LVVO

• 1.) MV pre-closure will occur before the QRS
• 2.) AV premature opening will occur right on or before the QRS
• 3.) Diastolic fluttering on the ALMV, IVS, AV
• 4.) Decreased MV excursion

the MV is not allowed to snap open as usual because of the extra pressure exerted on it.

• 1.) Color to locate the jet.
• 2.) CW to get velocities
• 3.) M-mode to make sure the jet is in diastole.

the width and the length of the jet into the LV

the steeper the slope of AI with CW

Mild AI = tips of the PM

Mod. AI = base of the PM

Severe AI = ventricular apex

vena contracta

Measure the diameter right at the valve.

• 1.) LV diastolic compliance
• 2.) LA pressure
• 3.) HR (brady or tachy)

Can alter the LV diastolic filling pressure causing the deceleration rate and half-time unreliable.