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Summary of the Day

Apgar Score

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Question of the Day

A 55-year-old man presents with Type A aortic dissection and severe aortic regurgitation. Which of the following hemodynamic goals will MOST likely reduce the aortic regurgitant fraction?

Question of the Day
A 55-year-old man presents with Type A aortic dissection and severe aortic regurgitation. Which of the following hemodynamic goals will MOST likely reduce the aortic regurgitant fraction?
Your Answer
Correct Answer

Explanation

Aortic regurgitation (AR) represents a volume overload lesion of the left ventricle. The degree of AR is related to the pressure gradient between the aorta and the left ventricle during the diastolic time period. Chronic AR progresses slowly over time, allowing the left ventricle to develop eccentric left ventricular hypertrophy as compensation. This causes the ventricle to become thickened in a concentric fashion but also the ventricular radius increases. The heart becomes thickened, but also dilated and enlarged. Stroke volume is increased but due to the increased ventricular radius, wall stress is elevated. Eventually ventricular function decreases and congestive heart failure ensues. Acute AR happens in situations such as aortic dissection and there is not enough time to develop ventricular eccentric hypertrophy. Thus the regurgitant volume causes very high left ventricular end diastolic pressure, acute LV failure, acute mitral regurgitation, increased left atrial pressure and pulmonary congestion. The hemodynamic goals for AR include: normal sinus rhythm with a relatively faster heart rate such as 80-90 beats per minute (reduces time in diastole for regurgitation), maintain preload, reduce afterload, and maintain myocardial contractility.

OA Series: June 2024

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