Aortic Regurgitation in Emergency Medicine Workup

Author: Jerry Balentine, DO; Chief Editor: David FM Brown, MD more...

Updated: Dec 5, 2011

What would you like to print?

Laboratory Studies
Imaging Studies
Other Tests
Show All

References

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

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^[6]
- 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.

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.

Proceed to Treatment & Management

Contributor Information and Disclosures

Author

Jerry Balentine, DO Professor of Emergency Medicine, New York College of Osteopathic Medicine; Executive Vice President, Chief Medical Officer, Attending Physician in Department of Emergency Medicine, St 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.

Coauthor(s)

Eric C Appelbaum, DO Associate Medical Director, Ambulatory Care, Associate Director, Emergency Department, St Barnabas Hospital, Bronx

Eric C Appelbaum, DO, is a member of the following medical societies: American College of Osteopathic Emergency Physicians, American College of Osteopathic Internists, and American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Management position; ProceduresConsult.com Royalty Other

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

David FM Brown, MD Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Elizabeth Kassapidis, DO, to the development and writing of this article.

References

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].
Braunwald E. Heart Disease: A Textbook of Cardiovascular Medicine. 3^rd ed. Philadelphia, Pa: Saunders; 1988.
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].
Giuliani E. Cardiology: Fundamentals and Practice. 2^nd ed. Philadelphia, Pa: Mosby Year Book; 1991.
Kloner R. The Guide to Cardiology. 2^nd ed. New York: Le Jacq Communications; 1990.
Lancellotti P, Tribouilloy C, Hagendorff A, Moura L, Popescu BA, Agricola E, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr. Apr 2010;11(3):223-44. [Medline].
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].
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].
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].
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].

View Table List

Read more about Aortic Regurgitation in Emergency Medicine on Medscape

Aortic Regurgitation in Emergency Medicine Workup

Laboratory Studies

Imaging Studies

Other Tests