Reflux of blood from the aorta through the aortic valve into the left ventricle during diastole

Aetiology

Acute causes

• Infective endocarditis and aortic dissection are the most common acute causes of AR
• Traumatic rupture of the valve leaflets e.g. blunt chest trauma
• Iatrogenic e.g. balloon valvotomy, TAVI

Chronic causes

• Valve disease
  • Calcific aortic valve disease (age related)
  • Myxomatous degeneration
  • Congenital disease e.g. bicuspid aortic valve
  • Rheumatic heart disease - most common cause in the developing world
  • Infective endocarditis
  • Rheumatic causes e.g. rheumatoid arthritis, antiphospholipid syndrome
  • Marfan's syndrome
• Aortic root dilation
  • Congenital bicuspid aortic valve
  • Genetic syndromes e.g. Marfan's, Ehlers-Danlos, osteogenesis imperfecta
  • Systemic vasculitides e.g. giant cell arteritis (GCA), Takayasu's arteritis

Clinical features

Acute AR

• Sudden cardiovascular collapse
• Pulmonary oedema
• Pallor
• Sweating
• Peripheral vasoconstriction

Chronic AR

• Usually significant symptoms occur late, do not develop until LV failure develops
• Exertional dyspnoea
• Orthopnoea