Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 10-15: Aortic Regurgitation + Key Features Download Section PDF Listen +++ ++ Rheumatic causes less common since advent of antibiotics Nonrheumatic causes predominate Congenitally bicuspid valve Infective endocarditis Hypertension Marfan syndrome Aortic dissection Ankylosing spondylitis Rarely atherosclerotic in nature + Clinical Findings Download Section PDF Listen +++ ++ High-pitched, decrescendo aortic diastolic murmur along the left sternal border; no change with respiration Hyperactive, enlarged left ventricle (LV) Wide pulse pressure with peripheral signs Water-hammer pulse or Corrigan pulse: rapid rise and fall with an elevated systolic and low diastolic pressure Quincke pulses: pulsatile nail beds Duroziez sign: to and fro murmur over a partially compressed femoral peripheral artery Musset sign: head bob with each pulse Hill sign: leg systolic pressure > 40 mm Hg higher than arm Angina pectoris or atypical chest pain may occasionally be present Associated coronary artery disease and syncope are less common than in aortic stenosis Exertional dyspnea and fatigue are the most frequent symptoms, but paroxysmal nocturnal dyspnea and pulmonary edema may also occur Usually slowly progressive and asymptomatic until middle age, although onset may sometimes be rapid, as in infective endocarditis or aortic dissection + Diagnosis Download Section PDF Listen +++ ++ ECG: LV hypertrophy Chest radiograph: Cardiomegaly with LV prominence and sometimes aortic dilation Doppler echocardiography Confirms the diagnosis Estimates severity Annual echocardiographic assessments of LV size and function are critical in determining the timing of valve replacement when the aortic regurgitation is severe CT or MRI Can estimate aortic root size Can exclude ascending aneurysm Cardiac catheterization Can help quantify severity Can evaluate the coronary and aortic root anatomy preoperatively + Treatment Download Section PDF Listen +++ ++ Medications that decrease afterload can reduce regurgitation severity Current recommendations advocate afterload reduction when there is associated systolic hypertension (systolic > 140 mm Hg) Angiotensin receptor blockers (ARBs) Preferred over beta-blockers as additions to medical therapy in patients with Marfan disease Reduce aortic stiffness (by blocking TGF-beta) and slow the rate of aortic dilation Elective surgery is indicated Once aortic regurgitation causes symptoms Before symptoms emerge for those who have an ejection fraction < 50% or increasing end-systolic LV volume For asymptomatic ascending aneurysm indicated when maximal dimension > 5.0 cm (> 4.5 cm in patients with Marfan syndrome) Urgent surgery is indicated in acute aortic regurgitation (usually due to endocarditis or dissection) Operative mortality is usually 3–5%