1. AORTIC
REGURGITATION
DR.V.K.RAJAMANI

2. • WHAT ARE THE SYMPTOMS
OF AORTIC REGURGITATION ?

3. CHRONIC SEVERE AORTIC REGURGITATION:
Asymptomatic: 10-15 Years
*PALPITATION - early symptom
*HEAD POUNDING - on exertion
*EXERTIONAL DYSPNOEA
*ORTHOPNOEA
*PAROXYSMAL NOCTURNAL DYSPNOEA
*EXCESSIVE DIAPHORESIS
*ANGINA - on exertion/ at rest
- nocturnal
*CCF - late

4. • DESCRIBE THE PULSE IN
AORTIC REGURGITATION

5. •Corrigan’s pulse
or
•Water hammer pulse
or
•Collapsing pulse
- Rapid rise and rapid fall
•Bisferiens’s pulse -two peaks in systole

6. •DESCRIBE THE HEART SOUNDS IN
AORTIC REGURGITATION

7. S1- may be soft due to premature closure of the
mitral valve.
A2 –normal or accentuated when AR is due to aortic root
disease.
S2- absent
or single
or exhibit narrow
or paradoxical splitting
S3 GALLOP - due
to increased LV end diastolic volume or
impaired LV function
Systolic ejection sound - related to abrupt distention of the
aorta by the augmented stroke volume.

8. •DESCRIBE THE MURMURS
OF AORTIC REGURGITATION

9. CHRONIC AORTIC REGURGITATION
Early diastolic murmur
*High pitched, blowing decrescendo
*Best heard in the 3rd left intercostal space
-with the patient sitting up and leaning forward
-breath held in forced expiration
*Aortic root disorders- murmur is best heard along right sternal border
*Cooving or musical murmur- evertion or perforation of the aortic cusps
*Longer the duration of murmur severer the aortic regurgitation
*Becomes short - cardiac failure

10. Ejection systolic murmur- flow murmur
- best heard at the base of the heart.
- transmitted along the carotids.
Austin flint murmur
* Soft, low pitched rumbling mid diastolic
murmur.
* Diastolic displacement of the anterior leaflet of
the mitral valve by the aortic regurgitation stream.
* Auscultatory events- intensified by handgrip.

11. •WHAT ARE THE PERIPHERAL SIGNS
OF AORTIC REGURGITATION ?

12. 1.Traube’s sign:
Pistol shot sounds
-booming systolic and diastolic sounds
heard over the femoral arteries.
2.Muller sign:
Systolic pulsations of the uvula.
3.Duroziez sign:
Systolic murmur over the femoral artery, when
compressed proximally. Diastolic murmur when
compressed distally.

13. 4.Quincke sign:
capillary pulsations detected
by pressing a glass slide on the lips or
by transmitting a light through the patient’s fingertips or
by exerting gentle pressure on the tip of a finger nail.
5.De Musset sign:
Bobbing of head with each heart beat.
6.Hill sign:
Popliteal cuff systolic pressure exceeding brachial cuff
systolic pressure by more than 20 mmHg.

14. • How will you differentiate
aortic regurgitation murmur from
pulmonary regurgitation murmur ?

15. *Pulmonary regurgitation murmur is often heard in patients with
severe pulmonary hypertension. Hence it is associated with loud
P2.
*Pulmonary regurgitation murmur is better heard during
inspiration while aortic regurgitation murmur is better heard
during expiration.
*Aortic regurgitation murmur is often associated with peripheral
signs of aortic regurgitation.

16. •How will you distinguish
Austin flint murmur from
Organic mitral stenosis murmur?

17. *Opening snap
In favour
*Loud first heart sound of
mitral stenosis
*Loud P2 due to pulmonary
hypertension

18. • What are the clinical signs of
acute aortic regurgitation ?

19. •Patients with acute severe aortic regurgitation appear gravely ill
•Tachycardia
•Peripheral cyanosis
•Peripheral signs of aortic regurgitation are absent/not impressive
•Left ventricle impulse is normal
•Rocking motion of chest is absent
•Signs of pulmonary congestion/ oedema

20. • WHAT ARE THE CAUSES OF
ACUTE AORTIC REGURGITATION?

21. •Infective endocarditis
•Prosthetic valve dysfunction
•Aortic dissection
•Trauma
•Systemic hypertension

22. • What are the causes of
chronic aortic regurgitation?

23. *Rheumatic heart disease
*Congenital bicuspid aortic valve
*Infective endocarditis
*Aortic root dilatation
*In association with other diseases

24. •CONGENITAL
-VSD
-Supravalvular aortic stenosis
-Discrete subvalvular aortic stenosis
-Aneurysm of the sinus of valsalva
•CONNECTIVE TISSUE DISEASE
* Marfan’s syndrome
* Osteogenesis Imperfecta
* Ehlers-danlos syndrome

25. •AUTO IMMUNE DISEASES
* Ankylosing spondylitis
* Rheumatoid arthritis
* Systemic lupus erythematosus
•SYPHILIS
•VARIOUS FORMS OF AORTITIS OR ARTERITIS
eg: Giant cell arteritis
Takayasu’s disease
•DRUGS- ANORECTIC DRUGS
*Fenfluramine
*Dexfenfluramine