eMedicine Specialties > Emergency Medicine > Cardiovascular

Aortic Regurgitation: Differential Diagnoses & Workup

Author: Jerry Balentine, DO, Professor of Emergency Medicine, New York College of Osteopathic Medicine; Senior Vice President, Chief Medical Officer, Medical Director, Attending Physician in Department of Emergency Medicine, Saint Barnabas Hospital
Contributor Information and Disclosures

Updated: Aug 19, 2008

Differential Diagnoses

Abdominal Trauma, Blunt
Mitral Stenosis
Acute Coronary Syndrome
Myocardial Infarction
Congestive Heart Failure and Pulmonary Edema
Endocarditis
Mitral Regurgitation

Workup

Laboratory Studies

  • CBC
  • Prothrombin time (PT)/activated partial thromboplastin time (aPPT)
  • Type and screen
  • Electrolytes
  • Myocardial muscle creatine kinase isoenzyme (CK-MB)
  • Lactate dehydrogenase panel
  • Isoenzymes

Imaging Studies

  • Chest radiography
    • Acute aortic regurgitation
      • Minimal cardiac enlargement
      • Normal aortic root/arch
      • Pulmonary venous pattern increased
    • Chronic aortic regurgitation
      • Marked cardiac enlargement
      • Prominent aortic root/arch
      • Normal pulmonary venous pattern
  • 2-Dimensional echocardiogram, transesophageal
    • Acute aortic regurgitation
      • Valve anatomy disrupted
      • Intimal flap
      • Vegetations on valve
      • Pericardial effusion
    • Chronic aortic regurgitation
      • Valve anatomy disrupted
      • Estimation of degree of regurgitation
      • Aortic root size and anatomy
      • Left ventricular function
  • Radionuclide techniques
    • These allow for determination of regurgitant fraction and left ventricular/right ventricular stroke-volume ratio. In the absence of mitral regurgitation and tricuspid regurgitation, a left ventricular/right ventricular stroke-volume ratio of 2.5 or more denotes severe aortic regurgitation.
    • Demonstration of a fall in ejection fraction with exercise is one of the best indicators for surgery in patients who are asymptomatic.
  • Cardiac catheterization/angiography
    • Consider for patients with coronary artery disease who are possible candidates for aortic valve replacement, those with a complex lesion associated with a diastolic murmur of unknown cause, and those with left ventricular dysfunction out of proportion to the degree of aortic regurgitation.
    • Assess the anatomy of the aorta and coronary ostia. Findings are usually normal except for visible reflux of dye from the aortic root into the ventricle.

See Aortic Regurgitation in the Radiology volume for images.

Other Tests

  • ECG
    • Normal (early in disease)
    • Left axis deviation (chronic aortic regurgitation)
      Specific waves
    • Specific waves
      • Prominent Q wave in I, AVF, V3 to V6
      • Small R wave in V1
      • T wave inverted with ST-segment depression
      • P-R prolongation (possible)
    • Of patients in a study done at the Mayo Clinic, 22% had atrial fibrillation. This is uncommon before disease has become advanced and has an ominous prognosis unless caused by another disease.

More on Aortic Regurgitation

Overview: Aortic Regurgitation
Differential Diagnoses & Workup: Aortic Regurgitation
Treatment & Medication: Aortic Regurgitation
Follow-up: Aortic Regurgitation
References
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References

  1. Babu AN, Kymes SM, Carpenter Fryer SM. Eponyms and the diagnosis of aortic regurgitation: what says the evidence?. Ann Intern Med. May 6 2003;138(9):736-42. [Medline].

  2. Braunwald E. Heart Disease: A Textbook of Cardiovascular Medicine. 3rd ed. Philadelphia, Pa: Saunders; 1988.

  3. Giuliani E. Cardiology: Fundamentals and Practice. 2nd ed. Philadelphia, Pa: Mosby Year Book; 1991.

  4. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. Feb 16 2000;283(7):897-903. [Medline].

  5. Hwang MS, Chu JJ, Su WJ. Natural history and risk stratification of discrete subaortic stenosis in children: an echocardiographic study. J Formos Med Assoc. Jan 2004;103(1):17-22. [Medline].

  6. Kloner R. The Guide to Cardiology. 2nd ed. New York: Le Jacq Communications; 1990.

  7. Tops LF, Kapadia SR, Tuzcu EM, Vahanian A, Alfieri O, Webb JG, et al. Percutaneous valve procedures: an update. Curr Probl Cardiol. Aug 2008;33(8):417-57. [Medline].

  8. Saura D, Peñafiel P, Martínez J, de la Morena G, García-Alberola A, Soria F, et al. [The frequency of systolic aortic regurgitation and its relationship to heart failure in a consecutive series of patients]. Rev Esp Cardiol. Jul 2008;61(7):771-4. [Medline].

  9. Sambola A, Tornos P, Ferreira-Gonzalez I, Evangelista A. Prognostic value of preoperative indexed end-systolic left ventricle diameter in the outcome after surgery in patients with chronic aortic regurgitation. Am Heart J. Jun 2008;155(6):1114-20. [Medline].

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Further Reading

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Keywords

aortic regurgitation, aortic insufficiency, aortic valve, aortic valve regurgitation, Corrigan disease, Corrigan's disease, aortic valve incompetence

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Contributor Information and Disclosures

Author

Jerry Balentine, DO, Professor of Emergency Medicine, New York College of Osteopathic Medicine; Senior Vice President, Chief Medical Officer, Medical Director, Attending Physician in Department of Emergency Medicine, Saint Barnabas Hospital
Jerry Balentine, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American College of Physician Executives, American Osteopathic Association, and New York Academy of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Suzanne White, MD, Medical Director, Regional Poison Control Center at Children's Hospital, Program Director of Medical Toxicology, Associate Professor, Departments of Emergency Medicine and Pediatrics, Wayne State University School of Medicine
Suzanne White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Clinical Toxicology, American College of Epidemiology, American College of Medical Toxicology, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gary Setnik, MD, Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School
Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians and National Association of EMS Physicians
Disclosure: Intellicare Salary Management position; South Middlesex EMS Consortium Salary Management position

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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