Aortic insufficiency

With aortic insufficiency or aortic insufficiency short (AI ) of the defective closure of the aortic valve of the heart and consequent diastolic backflow of blood from the aorta is referred to in the left ventricle in medicine.

Mild forms of aortic regurgitation can frequently be observed in an ultrasound examination of the heart. Moderate and severe forms have become less frequent in recent years, as the rheumatic fever is formerly recognized as the most common cause of valvular disease and treated with antibiotics.

Causes

A congenital aortic valve insufficiency is rare. Frequently, however, come before igniting related insufficiencies that can be caused rheumatic or bacterial. Here, bacterial colonies stored on the heart valve, so that it ( similar to the " fraying " of sails or flags ) and leaking is scarred after recovering from inflammation. A special form is the syphilitic aortitis (syn. Luica aortitis, syphilitic aortitis ) in syphilis.

In addition, atherosclerosis, connective tissue disease (eg Marfan syndrome when ) or over-stretching of the ascending aorta with aortic dissection trigger of aortic regurgitation.

Pathophysiology

Depending on the extent of chronic aortic regurgitation and the height of the drain resistance in the aorta of the left ventricle can be up to 2/3 of the ejection volume ( normal stroke volume 40-70 ml) the reverse current volume. This leads to a characteristic of high blood pressure amplitude. This increases the swing blood diastolic filling of the left ventricle, leading to a volume load of this portion heart as a result of which results in an eccentric hypertrophy. At first, the ratio of wall thickness to volume remains in the normal range. An increased extensibility sets the left ventricle in a position to take larger volumes without stronger increase in end-diastolic pressure. After many decades of course it comes through the overload also contributes to muscular dysfunction of the heart muscle so that it gradually comes to a serious left ventricular failure.

In an acute onset of aortic insufficiency (eg after Aortenklappenabriss, Klappenperforation or sudden inability closing in aortic dissection ), there is an immediate increase in end-diastolic pressure in the left ventricle (possibly up to 60 mm Hg ). This leads to pulmonary congestion, pulmonary edema, and reduction of cardiac output. The high pressure rise in Mitralklappenschluss occurs prematurely - a clear sign of a serious AI. The blood pressure amplitude can remain the same, in contrast to chronic AI, especially if the patients are tachycardic.

Symptoms

Milder forms are not noticed by the person concerned. When pronounced forms provides the ultimate symptom of breathlessness dar. Other possible symptoms or findings are:

• Large blood pressure amplitudes with low diastolic blood pressure, for example 150/60 mm Hg
• Heart Murmurs:

• Pulse: celer et altus (water hammer pulse) with extra beats, Homo pulsans, pulssynchronem nod ( Musset 's sign), Karotidenpulsation ( Corrigan 's sign), visible Kapillarpuls ( Quincke's sign).
• ECG changes with signs of left ventricular load ( Sokolow -Lyon index)
• X-ray: Enlargement of the left ventricle as a " shoe shape ", rounded apex
• Fever with endocarditis

Diagnostics

• Auscultation
• Echocardiography, today the fastest and best method
• ECG
• Cardiac catheterization
• Chest X-ray
• Phonokardiografie

Classification of severity

Therapy

At low reflux therapy is not required. For a medical therapy with afterload -reducing drugs (calcium antagonists, nitro compounds, ACE inhibitors, etc. ) proof of efficacy is lacking, if not the same for hypertension is. A surgical treatment by means of artificial heart valve should ( greater than 50 mm ejection fraction less than 50 %, diameter of the left ventricle ) are considered in symptoms (eg shortness of breath ) or signs of overload of the left heart.