Aortic Regurgitation
- Soft, decrescendo murmur that starts right at S2 and trails off (turbulence is highest in early diastole when the pressure gradient between the aorta and LV is highest).
- Murmur may be best heard with the patient leaning forward, holding their breath after a full exhalation.
- This murmur is classically associated with a wide pulse pressure, due to the larger than normal cardiac output (blood coming from both the left atrium and the blood leaking back from the aorta). The diastolic pressure is lower as blood is running off in both directions, and the vasculature peripherally is open to accommodate the increased forward flow (autoregulation). This causes the classic water hammer pulse, which can be felt in the radial pulse, and the Corrigan’s pulse (a large, bounding carotid pulse)
Patient 1:
This is a middle-aged woman with a history of thoracic aortic aneurysm complicated by a type A dissection status-post valve-sparing aortic root replacement, who has subsequently developed moderate to severe aortic regurgitation. Note the presence of a systolic murmur in addition to the long decrescendo diastolic murmur. The systolic murmur is a “flow” murmur related to the increased volume of blood moving through the aortic valve with every beat
Aortic Regurgitation
Annotated
Aortic Regurgitation
Annotated
Patient 2:
This is an older man with an aortic root aneurysm complicated by moderate to severe aortic regurgitation.
This patient also has Corrigan’s pulse, a bounding peripheral pulse, bisferiens pulse, and de Musset’s sign.
Aortic Regurgitation
Annotated
Aortic Regurgitation
Annotated
Patient 3:
This is a young man with intravenous drug use who was admitted to the hospital with infective endocarditis of the aortic valve resulting in severe aortic regurgitation.
This patient also has an Austin Flint murmur over the apex, bounding peripheral pulses, and Cheyne-Stokes respirations.
Aortic Regurgitation
Annotated
Patient 4:
This is a middle-aged man with active intravenous drug use who was found to have infective endocarditis of the aortic valve resulting in destruction of the non-coronary cusp of the aortic valve and severe aortic regurgitation. In addition to the diastolic and systolic murmurs, there is an extra transient sound near S1, likely an ejection click.
This patient also has Traube’s sign.
Aortic Regurgitation
Annotated
Patient 5:
This is a middle-aged man with Marfan’s syndrome complicated by severe aortic regurgitation. There is also a split S1 from a right bundle branch block.
Aortic Regurgitation
Annotated
Patient 6:
This is an older man with severe aortic regurgitation from infective endocarditis.
This patient also has an Austin Flint murmur and pitting edema.
Patient 7:
This is a middle aged man admitted with alcohol withdrawal. Incidental findings on cardiac exam. Extra heart sound near S1 over base and LLSB, 1/4 decrescendo diastolic murmur over Erb’s point. ECHO showed severely dilated aortic root and ascending aorta with moderate AR.
Patient 8:
This is a young man with severe aortic regurgitation secondary to severe infective endocarditis. Also note the physiologically split S2.
Patient 9:
This is an older man with severe aortic regurgitation. Notice that the murmur gets louder after a pause, a feature that helps distinguish this murmur from mitral regurgitation.
Patient 10
This is an older man with severe aortic regurgitation. Note the radiation to the apex where the murmur takes on a “musical” quality. This is known as Gallavardin’s phenomenon
Patient 11
This is a young man with severe aortic regurgitation related to infective endocarditis.
Patient 12:
This is a patient with aortic regurgitation and pulmonic regurgitation.