Aortic Insufficiency Aortic Regurgitation


Categories: Uncategorized
Sources: Disturbances Of The Heart

This lesion, though not so common as the mitral lesion, is of not

infrequent occurrence in children and young adults as a sequence of

acute rheumatic endocarditis. If it occurs later in life it

generally is associated with aortic narrowing, and is a part of the

general endarteritis and perhaps atheroma of the aorta. Sometimes it

is caused by strenuous exertion apparently rupturing the valve.



This form of valvular disease frequently ends in sudden death. On

the other hand, it is astonishing how active a person may be with

this really terrible cardiac defect. This lesion, from the frequent

overdistention of the left ventricle, is one which often causes

pain. While the left ventricle enlarges enormously to overcome the

extra distention due to the blood entering the ventricle from both

directions, the muscle sooner or later becomes degenerated from poor

coronary circulation. Unless the left ventricle can do its work well

enough to maintain an adequate pressure of blood in the aorta, the

coronary circulation is insufficient, and chronic myocarditis is the

result. If the left ventricle has maintained this pressure for a

long time, edemas are not common unless the cardiac weakness is

serious and generally permanently serious: that is, slight weakness,

in this lesion, does not give edemas as does slight loss of

compensation in mitral disease, and unless the weakness of the

ventricle is serious, the lungs are not much affected.



The physical sign of this lesion is the diastolic murmur, which is

loudest of the base of the heart, is accentuated over the aortic

orifice, and is transmitted up into the neck and the subclavians,

and down over the heart and down the sternum with marked pulsation,

of the arteries (Corrigan pulse) and often of some of the peripheral

veins, notably of the arms and throat.



If the left ventricle becomes dilated the mitral valve may become

insufficient, when the usual lung symptoms occur, with hypertrophy

of the right ventricle; and if it fails, the usual venous symptoms

of loss of compensation follow. This lesion not infrequently causes

epistaxis, hemoptysis and hematemesis.



Digitalis is always of value in these cases, but it should not be

pushed. If a heart is slowed too much, the regurgitation into the

left ventricle is increased. Therefore such hearts should not be

slowed to less than eighty beats per minute, or sudden anemia of the

brain and sudden death may occur. These patients must not do hard

work.





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