NATURAL HISTORY OF AR PPT.pptx acute vs chronic

acute ar vs chronic ar, etiology of both,phases of chroinc ar ,patho physiology and hemodynamics of each phase .effect of surgery avr and survival rates in each phase,predictors of out come and take home message

1. NATURAL HISTORY OF AORTIC REGURGITATION DR.HARI KUMAR BANDI 1st YEAR CARDIO RESIDENT MODERATOR- DR.ANAND MD,DM CARDIOLOGY

2. ETIOLOGY OF CHRONIC AORTIC REGURGITATION LEAFLET ABNORMALITIES Rheumatic disease Aortic valve sclerosis and calcification Congenital abnormalities (bicuspid, unicuspid , and quadricuspid valves; aortic regurgitation associated with discrete subaortic stenosis and ventricular septal defect) Infective endocarditis Myxomatous valve disease Complicating balloon valvuloplasty and transcatheter aortic valve implantation Rare causes (drugs, leaflet fenestration, irradiation, nonbacterial endocarditis , trauma)

3. AORTIC ROOT ABNORMALITIES Chronic hypertension Marfan syndrome Annulo -aortic ectasia Aortic dissection Ehlers- Danlos syndrome Osteogenesis imperfecta Atherosclerotic aneurysm Syphilitic aortitis Other systemic inflammatory disorders (giant cell aortitis , Takayasu disease, Reiter syndrome) VALVE AND AORTIC ROOT ABNORMALITIES Bicuspid aortic valve Ankylosing spondylitis

4. NATURAL HISTORY PHASES ASYMTOMATIC/COMPENSATED TRANSITION/SUB CLINICAL SYMPTOMATIC/DECOMPENSATED

5. PATHOPHYSILOGY VOLUME OVER LOAD LV MASS LV REMODELLING STROKE VOLUME EFFECTIVE STROKE VOLUME DIASTOLIC PRESSURE & TIME LVSD & LVEDP MI

6. ASYMPTOMATIC/COMPENSATED PHASE LASTS FOR DECADES STROKE VOLUME MAINTAINED LV FUNCTION NORMAL NO SYMPTOMS WIDE PULSE PRESSURE DIASTOLIC MURMUR

7. SURVIVAL RATE MORTALITY < 0.2%/Y PROGRESSION TO SYMPTOMS 4-6%/Y

8. TRANSITION /SUB CLINICAL PHASE PROGRESSIVE LV DILATATION-COR BOVINUM LV FUNCTION EF-50-55% REMAIN ASYMPTAMATIC AT REST MILD EXERCISE INTOLERACE

9. SYMPTOMATIC/DECOMPENSATED PHASE LV DILATATION LV DYSFUNCTION (EF< 50%) LVEDP,STROKE VOLUME SYMPTOMS EXERTIONAL DYSPNOEA,FATIGUE,PALPITATIONS,ANGINA CHF –ORTHOPNOEA,PND,EDEMA ALLPERIPHERAL SIGNS

10. SURVIVAL RATE ANGINA – 4YEARS HEART FAILURE -2 YEARS

11. PREDICTORS OF OUT COME SYMPTOMS LV FUNCTION(EF-55%) LV DILATATION (LVESD>50 MM OR 25 MM/M2

12. ACUTE AR INFECTIVE ENDOCARDITIS AORTIC DISSECTION TRAUMA

13. HEMODYNAMICS STROKE VOLUME LV FUNCTION, LV SIZE LVEDV , LVEDP SYMPTOMS CHF PFOFOUND HYPOTENSION CARDIOGENIC SHOCK SUDDEN COLLAPSE

14. FINAL TAKE CHRONIC AR WELL TOLERATED FOR YEARS DUE TO LV REMODELLING ON SET OF SYMPTOMS, LV FUNCTION, LVESD -OUT COME PREDICTORS AVR INDICATED TO PREVENT IRREVERSIBLE DETERIORATION ACUTE AR- IMMEDIATE INTERVENTION.

15. THANK YOU

16. ETIOLOGY OF CHRONIC AR