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)

Card Tutorial

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

This patient also has Corrigan’s pulse and Quincke’s pulse.

Aortic Regurgitation

Annotated

Aortic Regurgitation

Annotated

This patient also has

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