• Commonly seen in Rheumatic cardiac disease

PATHOLOGY

• Volume overload on the left ventricle
• Dilatation and hypertrophy of the left ventricle.

Combined mitral and aortic insufficiency are more common than aortic involvement alone.

CLINICAL MANIFESTATIONS.

• Palpitations.  
• Excessive sweating
• Dyspnoea on exertion
• Orthopnea
• Pulmonary oedema angina

SIGNS

• Pulse pressure is wide  
• Bounding peripheral pulses.  
• Raised systolic blood pressure
• Left ventricular apical heave.
• Diastolic thrill-
• Begins with 2nd heart sound continues until late in diastole.
• Heard over upper and middle left sternal border with radiation to apex/ aortic area.  

INVESTIGATIONS

Chest Xray- Enlargement of the left ventricle and aorta.  

Electrocardiogram – signs of left ventricular hypertrophy and strain with prominent P waves.

Echocardiogram-

• Large left ventricle  
• Diastolic mitral valve flutter caused by regurgitant flow.
• Doppler studies demonstrate the degree of aortic runoff into the left ventricle.   

PROGNOSIS AND TREATMENT.

Mild and moderate lesions are well tolerated.  

Aortic insufficiency does not regress.  

Surgical intervention (valve replacement)

Criteria

• Increasing left ventricular dimensions on the echocardiogram.   
• ST-T wave changes on the electrocardiogram
• Decreasing left ventricular ejection fraction.