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 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

This patient also has

Related signs

Austin Flint Murmur