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AORTIC REGURGITATION

CHIEF COMPLAINT

• Fatigue
• Shortness of breath
• Edema
• Chest pain
• Exertional dyspnea
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Abdominal discomfort
• Syncope
• Nocturnal angina
• Diaphoresis
• Palpitations

HPI

SYMPTOM LIST

• Fatigue
• Shortness of breath
• Edema
• Chest pain
• Exertional dyspnea
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Abdominal discomfort
• Syncope
• Nocturnal angina
• Diaphoresis
• Palpitations

SEVERITY
• Mild
• Moderate
• Severe
• Absent
• Normal
• Increased
• Decreased
• Stable
• No significant change from prior visit

HISTORY (PMFSH)

PAST HISTORY

• Congenital heart defect


• Endocarditis
• Rheumatic fever
• Marfan syndrome
• Ankylosing spondylitis
• Syphilis
• Systemic lupus erythematosus
• Ehlers-Danlos syndrome
• Turner syndrome
• Hypertension
• Diabetes

FAMILY HISTORY

• Heart diseases
• Hypertension
• Diabetes
• Syphilis
• Connective tissue disorders

ALLERGY
• Drugs___
• Environment

SOCIAL HISTORY

Habits
•Alcohol
•Smoking
•Tobacco
•Drugs____
•Note
Occupation_____
ROS

PHYSICAL EXAMINATION

Heart exam
• Normal, RRR, no MRG
• Pulse
• Rate that was
o Tachycardic
o Bradycardic
• Rhythm was
o Regular
o Irregular
o Irregularly irregular
• Murmur
o Physiologic
o S-3
o S-4
o Mitral click
o Note

TESTS TO BE ORDERED

Blood tests

• CBC
• Prothrombin time (PT)
• activated partial thromboplastin time (aPPT)
• Myocardial muscle creatine kinase isoenzyme (CK-MB)
• Lactate dehydrogenase panel
• Isoenzymes
• Albumin levels
• Serum electrolyte tests
• Hb%
• Heamotocriet value
• FBS
• PLBS
• RBS

Urinalysis
o Macroscopic
 Urine Appearance.
 Urine Bilirubin
 Urine Blood
 Urine Casts
 Urine Color
 Urine Glucose
 Urine Ketones
 Urine pH
 Urine Protein
 Specific Gravity
 Urine Urobilinogen
o Microscopic
 Urine WBS/hpf
 Urine RBC/hpf
 Urine Casts
 Urine Other
• ECG
• Treadmill stress test
• Echocardiography
• Chest x-ray
• Transesophageal echocardiography (TEE)
• Cine nuclear magnetic resonance (cine NMR)
• Doppler ultrasound
• Aortic angiography
• Left heart catheterization
• Nuclear MRI imaging

ASSESSMENT/PLAN & INSTRUCTIONS/EDUCATION

•Echocardiographic follow-up for every 12 months


•Avoid smoking and second hand smoking
•Avoid too much salt intake
•Take antibiotic prophylaxis for endocarditis
•Don’t do vigorous athletic activity
•Don’t do isometric exercise
•Don’t do school physical education activities

SURGICAL TREATMENT

•Aortic valve replacement

MEDICATION
• Hydralazine
• Nitroprusside
• Nifedipine
• Prazosin
• Captopril
• Furosemide
• Propranolol
• Digoxin
• Benazepril
• Enalapril
• Fosinopril
• Lisinopril
• Perindopril
• Quinapril
• Ramipril
• Trandolapril
• Candesartan cilexetil
• Eprosartan
• Irbesartan
• Losartan potassium
• Olmesartan
• Telmisartan
• Valsartan
• Clonidine
• Doxazosin

FOLLOW-UP

Echocardiographic evaluation for every 6 months

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