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Aortic regurgitation
In chronic aortic regurgitation the left ventricle dilates and compensates for years, so surgery is timed by symptoms or by signs of ventricular failure (EF or diameter); in acute regurgitation there is no time to compensate — it is a surgical emergency.
Why it matters in the exam
Questions rest on the physical examination: a wide pulse pressure, a water-hammer pulse (Corrigan), head bobbing (de Musset), capillary pulsation (Quincke), and an early decrescendo diastolic murmur along the left sternal border, best heard sitting forward at end-expiration. An Austin Flint murmur — a diastolic murmur at the apex — may also be heard. Causes are asked too: aortic root dilation (Marfan, hypertension, aortitis, ankylosing spondylitis), bicuspid valve, endocarditis and rheumatic disease.
In acute regurgitation — from endocarditis or aortic dissection — the patient presents with pulmonary oedema and shock, without a wide pulse pressure, and the treatment is urgent surgery. An intra-aortic balloon pump is forbidden in significant aortic regurgitation. In Marfan syndrome candidates are asked the aortic root diameter at which surgery is done.
Key points
- Early decrescendo diastolic murmur at the left sternal border, louder sitting forward.
- Peripheral signs: wide pulse pressure, water-hammer pulse, de Musset, Quincke.
- Surgery: symptoms, or EF 50% or less, or end-systolic diameter above 50 mm.
- Acute regurgitation (endocarditis, dissection): urgent surgery; no balloon pump.
- Marfan: aortic root surgery at 50 mm or more.
Summary table
| Situation | Findings | Test | Treatment |
|---|---|---|---|
| Severe chronic regurgitation with symptoms | Breathlessness, wide pulse pressure, early diastolic murmur | Echocardiogram | Surgery |
| Severe chronic regurgitation without symptoms | Dilating left ventricle | EF 50% or less or end-systolic diameter above 50 mm | Surgery |
| Acute regurgitation | Pulmonary oedema and shock, no peripheral signs | Urgent echo, look for endocarditis or dissection | Urgent surgery; balloon pump forbidden |
| Dilated aortic root (Marfan) | Diastolic murmur, Marfan features | Echo, CT or MRI | Surgery at 50 mm or more (45 with risk factors) |
| Not a surgical candidate | Symptoms | — | Vasodilators (ACE inhibitor, ARB, dihydropyridine calcium blocker) |
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Sources
- ESC/EACTS Guidelines for the management of valvular heart disease, 2021 — Aortic regurgitation: evaluation and indications for surgery
- Harrison's Principles of Internal Medicine, 21st edition (2022) — Aortic Valve Disease
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.