Diagnostic Considerations

Physical examination findings suggesting a widened pulse pressure may also be seen in other conditions of hyperdynamic circulation, including the following:

Thyrotoxicosis
Severe anemia
Pregnancy
Thiamine deficiency (wet beriberi)
Arteriovenous fistula: Such as patent ductus arteriosus or peripheral arteriovenous malformations
Volume depletion
Sympathetic overdrive

Differential Diagnoses

Workup

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Media Gallery

Aortic regurgitation. Color Doppler echocardiogram.
Aortic regurgitation. Doppler echocardiographic signals may be reviewed to evaluate the severity of disease.
Aortic regurgitation. Two-dimensional (2D) color Doppler echocardiography.
Aortic regurgitation. Aortic-root angiography shows regurgitation of contrast material into the left ventricle (LV).
Aortic regurgitation. Chest radiograph in a patient with aortic dissection and acute aortic regurgitation shows a cardiac silhouette of essentially normal dimension.

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Table 1: Frequency of Followup of Patients With Aortic Regurgitation.

LVESD (mm)	LVEDD (mm)	Dimensions	Clinical Evaluation	Echocardiogram
< 45	< 60	Stable	6-12 months	12 months
< 45	< 60	Increasing	3 months	3 months
45-50	60-70	Stable	6 months	12 months
45-50	60-70	Increasing	3 months	3 months
50-55	70-75	Stable	6 months	6 months
50-55	70-75	Increasing	3 months	3 months
>55	>75		Surgery recommended

Table 2. Guidelines for Aortic Regurgitation Surgical Intervention

Aortic valve replacement (AVR) indications Note: STS guidelines recommend “valve replacement or valve repair”	AHA/ACC (2014)^[4]	ESC/EACTS (2012)^[43]	STS (2013)^[9]
Symptomatic severe AR	Class I	Class I	Class I
Asymptomatic chronic severe AR and left ventricular ejection fraction (LVEF) ≤50%	Class I	Class I	Class I
Severe AR when undergoing other cardiac surgery	Class I	Class I	Class I
Asymptomatic severe AR with normal LVEF (≥50%) but with severe LV dilation (LVESD >50mm)	Class IIa-Reasonable	Class IIa-Reasonable	Class IIa-Reasonable
Moderate AR when undergoing other cardiac surgery	Class IIa-Reasonable		Class IIb-Consider
Asymptomatic severe AR and normal LVEF (≥50%) but with progressive severe LV dilation (LVEDD >65 mm) if surgical risk is low	Class IIb-Consider	Class IIa-Reasonable	Class IIb-Consider
Not indicated for asymptomatic patients with mild, moderate, or severe AR and normal LV systolic function at rest when the degree of LV dilation is not moderate or severe			Class III

Back to List

Author

Stanley S Wang, JD, MD, MPH Clinical Cardiologist, Austin Heart South; Director of Legislative Affairs, Austin Heart; Medical Director, Sleep Disorders Center at Heart Hospital of Austin; Assistant Professor of Medicine (Adjunct), University of North Carolina School of Medicine

Stanley S Wang, JD, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, American Stroke Association, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Terrence X O'Brien, MD, MS, FACC Professor of Medicine/Cardiology, Director, Clinical Cardiovascular Research, Medical University of South Carolina College of Medicine; Director, Echocardiography Laboratory, Veterans Affairs Medical Center of Charleston

Terrence X O'Brien, MD, MS, FACC is a member of the following medical societies: American College of Cardiology, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, South Carolina Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

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.

Steven J Compton, MD, FACC, FACP, FHRS Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals

Steven J Compton, MD, FACC, FACP, FHRS is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Elizabeth Kassapidis, DO Resident Physician, Department of Emergency Medicine, New York College of Osteopathic Medicine and Saint Barnabas Hospital

Disclosure: Nothing to disclose.

Martin Gerard Keane, MD, FACC, FAHA Associate Professor, Cardiovascular Medicine Division, Department of Medicine, University of Pennsylvania School of Medicine

Martin Gerard Keane, MD, FACC, FAHA is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Heart Association, American Society of Echocardiography, Pennsylvania Medical Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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

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

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.