Page 130 - Clinical Pearls in Cardiology

118 Clinical Pearls in Cardiology

aortic regurgitation may experience angina type of chest
pain. This is the result of reduced coronary blood flow,
either due to associated coronary atherosclerosis or low
aortic root diastolic pressures or ostial narrowing of the
coronary arteries in conditions like syphilis.
However, as is the case for aortic stenosis, once the
patient becomes symptomatic, the downhill course
becomes rapidly progressive. Congestive heart failure,
punctuated by episodes of acute pulmonary edema,
and sudden death may occur, usually in previously
symptomatic patients who have considerable left
ventricular dilation. Data compiled in the presurgical era
indicated that without surgical treatment, death usually
occurred within 4 years after the development of angina
pectoris and within 2 years after the onset of symptoms
of heart failure. (Ref: Braunwald’s Heart Disease, 9th edn.
Saunders. 2012).
27. What is the significance of blood pressure in aortic
regurgitation?
Severe aortic regurgitation is unusual in a person with
a diastolic blood pressure greater than 60 mmHg.
Conversely, a diastolic blood pressure of 50 mmHg or
less is almost always indicative of a severe degree of
aortic incompetence, irrespective of the level of the
systolic blood pressure. Also, systolic blood pressure
more than 160 mmHg usually indicates the presence
of associated systemic hypertension in a person with
chronic aortic regurgitation. (Ref: Synopsis of cardiac
physical diagnosis; Abrams Butterworth-Heinemann;
2001). The pulse pressure is usually wide (often more
than 100 mm Hg). It is best to use the point of muffling