Study note
MedicineCardiology

Clinical features of aortic regurgitation

THE CONTEXT
Aortic regurgitation produces symptoms that vary with severity and characteristic pulse, murmur and cardiac findings.

Symptoms by severity

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Mild to moderate aortic regurgitation is often asymptomatic, although palpitations may occur.
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Severe aortic regurgitation can cause breathlessness and angina.

Pulse findings and peripheral signs

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The pulse is large-volume or collapsing, with low diastolic pressure, increased pulse pressure and bounding peripheral pulses.
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Quincke sign is capillary pulsation in the nail beds.
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Traube sign is a femoral bruit described as a ‘pistol shot’.
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Duroziez sign is a femoral systolic and diastolic, or to-and-fro, murmur.
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de Musset sign is head nodding with the pulse.

Murmurs and other cardiac findings

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Murmurs include an early diastolic murmur, a systolic murmur due to increased stroke volume, and the soft mid-diastolic Austin Flint murmur.
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Volume overload causes a displaced, thrusting apex beat.
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A pre-systolic impulse and a third heart sound may be present.
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Crepitations reflect pulmonary venous congestion.
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