Epidemiology: 50% due to aortic root dilatation (idiopathic or due to HTN/ageing), can be due to bicuspid aortic valve (15%), rheumatic fever (+endocarditis), marfans syndrome, aortic dissection, syphilis, SSRIs, rheumatoid arthritis, ankylosing spondylitis, acromegaly, osteogenesis imperfecta, ehlers danlos syndrome, reiters syndrome.
Clinical presentation: dyspnoea, palpitations, collapsing pulse, LVH/HF (due to pressure and volume overload).
Pathophysiology: aortic insufficiency due to a volume overload and pressure overload. The regurge fraction causes a decreased pressure in the aorta and an increased pressure in the LV = increased pulse pressure with an increasing systemic pressure due to reduced CO (=inc RAA etc).
Pathophysiology: Acute = CHF, Chronic = LVH and dilatation.
Investigations: CXR = cardiomegaly, pulmonary oedema.
Murmur: early diastolic murmur with a decrescendo and the upper right sternal edge (on expiration).
Treatment: ACEi (s/e: ankle swelling), nifedipine (CCB), hydralazine (s/e: lupus, pericarditis), aortic valve replacement, digoxin