Aortic Regurgitation Arterial Waveform — FRCA Final MCQ

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ModerateAnaesthetic Equipment & SafetyAortic Regurgitation Arterial WaveformFRCA Final

A 65-year-old man undergoing elective surgery has a radial arterial catheter. A fast-flush test confirms that the monitoring system has an appropriate dynamic response. The arterial pressure is 170/70 mmHg, and the waveform has a brisk systolic upstroke, a low and poorly defined dicrotic notch, and rapid diastolic runoff. Which condition is most consistent with these findings?

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Correct answer: C — Aortic regurgitation

Aortic regurgitation is the best answer. In chronic significant regurgitation, left ventricular volume loading increases total stroke volume, producing a brisk upstroke and high systolic pressure. Diastolic flow from the aorta back into the left ventricle lowers aortic diastolic pressure and causes rapid diastolic runoff. Together these produce the markedly widened pulse pressure and collapsing arterial waveform; the dicrotic notch may be low or poorly defined. Aortic stenosis instead causes a delayed, low-amplitude upstroke and usually a narrower pulse pressure. Hypovolaemia and cardiac tamponade reduce effective stroke volume, producing a narrow pulse pressure, often with prominent respiratory variation. A normal waveform would not have this combination of a 100 mmHg pulse pressure and rapid diastolic decline.

Reference: Kalra A, et al. Transcatheter and Doppler waveform correlation in transcatheter aortic valve replacement. Open Heart. 2018;5:e000728. https://pubmed.ncbi.nlm.nih.gov/29387431/