Austin Flint's breath

Specialty: Cardiovascular.

• audible Austin Flint murmur
• Austin Flint diastolic rumble

Why it occurs

• Chronic severe aortic valve insufficiency (the regurgitation jet collides with the anterior mitral leaflet, limiting its diastolic opening and generating functional mitral stenosis)
• Massive aortic regurgitation due to dissection or endocarditis
• Rupture of aortic root aneurysm resulting in large-volume acute aortic insufficiency

Initial workup

Transthoracic echocardiogram with color and tissue Doppler to quantify the degree of aortic insufficiency (PHT <200 ms, regurgitant volume >60 mL, effective regurgitant orifice >0.3 cm2), evaluate the diastolic excursion of the anterior leaflet of the mitral valve (search for "fluttering" or fluttering of the anterior leaflet due to the impact of the reflux jet), measure the left ventricular diameters and determine LVEF; 12-lead electrocardiogram; Chest x-ray.

Standard management

• Ramipril — ACEI to reduce afterload, reduce aortic regurgitant volume and limit the progression of left ventricular dilation; 5 to 10 mg once daily orally, monitoring that diastolic pressure does not drop critically
• Amlodipine — dihydropyridine calcium antagonist indicated for controlling blood pressure and reducing afterload; 5 to 10 mg per day orally
• Furosemide — loop diuretic indicated to reduce preload and relieve pulmonary venocapillary congestion; 20 to 40 mg per day orally
• Carvedilol (beta blocker that should be used with extreme caution in severe aortic insufficiency because the associated bradycardia prolongs diastole and increases regurgitant volume, indicated at very low doses only if there is demonstrated systolic dysfunction and clinical stability; start with 3,125 mg every 12 hours).