Aortic Regurgitation

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

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 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

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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