Aortic regurgitation natural history, complications and prognosis

Jump to navigation Jump to search

Aortic Regurgitation Microchapters

Home

Patient Information

Overview

Historical Pesrpective

Pathophysiology

Causes

Stages

Differentiating Aortic Regurgitation from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Cardiac Stress Test

Electrocardiogram

Chest X Ray

Echocardiography

Cardiac MRI

Treatment

Acute Aortic regurgitation

Medical Therapy
Surgery

Chronic Aortic regurgitation

Medical Therapy
Surgery

Precautions and Prophylaxis

Special Scenarios

Pregnancy
Elderly
Young Adults
End-stage Renal Disease

Case Studies

Case #1

Aortic regurgitation natural history, complications and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Aortic regurgitation natural history, complications and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Aortic regurgitation natural history, complications and prognosis

CDC on Aortic regurgitation natural history, complications and prognosis

Aortic regurgitation natural history, complications and prognosis in the news

Blogs on Aortic regurgitation natural history, complications and prognosis

Directions to Hospitals Treating Aortic regurgitation

Risk calculators and risk factors for Aortic regurgitation natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-in-Chief: Varun Kumar, M.B.B.S., Lakshmi Gopalakrishnan, M.B.B.S.

Overview

In acute aortic insufficiency symptoms of heart failure often develop acutely. Chronic aortic insufficiency is usually insidious and progressive and the patient may remain asymptomatic for years. Once left ventricular dilation and left ventricular failure occurs, dyspnea on exertion and exercise intolerance begins to occur. Later symptoms such as angina, syncope, and other symptoms of heart failure are present.

Natural History

Acute Aortic Insufficiency

In acute aortic insufficiency symptoms of heart failure such as pulmonary edema often develop acutely.

Chronic Aortic Insufficiency

Chronic aortic insufficiency is usually insidious and progressive and the patient may remain asymptomatic for years. Once left ventricular dilation and left ventricular failure occurs, dyspnea on exertion and exercise intolerance begins to occur. Later symptoms such as angina, syncope, and other symptoms of heart failure are present.

Complications

Acute Aortic Insufficiency

  1. Left ventricular volume overload in a non-compliant left ventricle with acute left ventricular failure
  2. Pulmnary edema
  3. Sudden cardiac death

Chronic Aortic Insufficiency

  1. Heart failure
  2. Arrhythmia
  3. Myocardial ischemia
  4. aortic dissection in patients with bicuspid aortic valve
  5. Infective endocarditis

Prognosis

The prognosis and survival of patients with symptomatic aortic regurgitation has improved significantly over the last decade. The five year survival rate for symptomatic patients is now more than 80 percent.

Acute Aortic Insufficiency

The prognosis among patients with aortic insufficiency is poor with a high mortality and morbidity due to the acute onset of left ventricular failure, pulmonary edema, myocardial ischemia due to the abrupt rise in LV wall stress and sudden cardiac death[1]. Early surgical intervention improves the prognosis in these patients.

Chronic Aortic Insufficiency

Asymptomatic Patients with Normal Ejection Fraction

  • Rate of progression to symptoms or left ventricular dysfunction ≤ 6% per year
  • Rate of progression to asymptomatic left ventricular dysfunction ≤ 3.5% per year
  • Rate of sudden death ≤ 0.2% per year

Asymptomatic Patients with Reduced Ejection Fraction

  • Rate of progression to symptoms ≥ 25% per year

Symptomatic patients

  • Mortality rate ≥ 10% per year

====Patients with Chronic Severe Aortic Insufficiency who are Managed Conservatively====[2]

  • Death from any cause - 4.7% per year
  • Congestive heart failure - 6.2% per year
  • Aortic valve surgery - 14.6% per year

Asymptomatic Patients

  • Mortality rate - 2.8% per year

Symptomatic Patients

References

  1. Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Retrieved 2011-04-19. Unknown parameter |month= ignored (help)
  2. Dujardin KS, Enriquez-Sarano M, Schaff HV, Bailey KR, Seward JB, Tajik AJ (1999). "Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study". Circulation. 99 (14): 1851–7. PMID 10199882. Retrieved 2011-04-19. Unknown parameter |month= ignored (help)

Template:WH Template:WS