Describe the heart sounds in aortic regurgitation

First heart sound (S₁)

          Intensity of S₁ is usually decreased, it is due to  the partial closure of mitral valve leaflet in presystole. It indicates that the aortic regurgitation is of moderate to severe intensity.

If the  patient has loud S₁ – think of coexisting mitral stenosis.

Comment on the A₂ in AR

          A₂ is usually variable.

          Loud A₂ is due to aortic root dilatation.

          Soft A₂ - is produced due to low ability of valve leafet to vibrate after the aortic valve closure.

Describe the split in AR

          Split may be normal, single S₂ or prodoxically split. 

What is the significance of S₃ in AR

Occur in AR due to increased LVEDV (Left ventricular end diastolic volume). Left ventricular dysfunction can also  cause LVS₃. LVS₃ is commonly associated with Austin – flint murmur and peripheral signs of aortic regurgitation. 

What is the significance of S₄ in AR

          Seen usually in severe AR.

What is the significance of Aortic ejection click in AR

1.    Seen in patients with mild AR with normal LV function.

2.    Valvular Ejection Click – is due to bicuspid aortic valve.

3.    Vascular ejection click– is due to Aortic root dilatation.