Aortic regurgitation

What it is

Aortic regurgitation is a diastolic murmur, heard between S2 and S1. Diastolic heart sounds include aortic and pulmonic regurgitation and mitral and tricuspid stenosis, and within diastole aortic regurgitation is an early diastolic murmur. That timing alone separates it from the systolic murmurs, which include aortic and pulmonic stenosis, mitral and tricuspid regurgitation, VSD and MVP.

How it presents

• Dyspnea is the most common complaint.
• The diastolic decrescendo murmur is the most typical finding, and it is best heard when the patient leans forward.
• Austin-Flint murmur.
• Duroziez sign: a systolic and/or diastolic thrill or murmur heard over the femoral arteries.
• S3 in early left ventricular decompensation.

At the bedside the murmur can be made louder. Hand grip raises afterload, and it increases the intensity of MR, AR and VSD murmurs, so a faint early diastolic murmur that grows with hand grip is more likely to be aortic regurgitation.

Causes and risk

Marfan syndrome carries aortic regurgitation with it. Cardiovascular defects in Marfan syndrome are progressive, aortic root dilation occurs in 80%-100% of affected individuals, and aortic regurgitation becomes more common with increasing age. The cardiac examination may reveal an aortic insufficiency murmur, or a murmur associated with mitral valve prolapse.

The rest of the syndrome stands beside the murmur: arachnodactyly, an arm span greater than height, a high arched palate, kyphosis, lenticular dislocation, mitral valve prolapse, myopia, and pectus excavatum.