What are the clinical signs of aortic regurgitation

Aortic regurgitation may produce the following clinical signs

1.    High volume collapsing pulse.

2.    High pulse pressure.

3.    Jugular venous pressure may be normal or raised.

4.    Forceful apex beat.

5.    Diastolic thrill may be present.

6.    Soft S1.

7.    Paradoxic splitting of S2.

8.    Left ventricular S3/S4.

9.    Ejection click may be present.

Loud P2 and left parasternal heave is seen if pulmonary artery hypertension present.

High pitched blowing decrescendo early diastolic murmur may be heard at neoaortic area. It may be conducted down the lower left sternal border.

Peripheral  signs of AR

Aortic regurgitation produce peripheral signs due to volume overload.

1.    Collapsing pulse.

2.    Pulses bisferiens.

3.    Demusset sign.

4.    Corrigan’s sign.

5.    Becker’s sign.

6.    Quincke sign.

7.    Hills sign.

8.    Duroziez sign.

9.    Pistal shot femorals.

10. Mullers sign.

11. Rosen back sign.

12. Gerhat’s sign.

Most important clinical signs are:

-          Collapsing pulse and peripheral signs.

-          Forceful apex.

-          Soft S1.

-          Early diastolic murmur (EDM) in 2^nd aortic area.

-          Mid diastolic murmur (MDM) at mitral area.

What is the apex beat in AR

          It is displaced and forceful.

          Undisplaced and forceful in mild to moderate AR.

Describe the palpatory findings in AR

1.   Forceful apex beat.

2.   Diastolic thrill may be present.

What are the causes of AR with absent peripheral signs ?

1.    Mild AR.

2.    Acute AR.

3.    AR with the following

-        Left ventricular dysfunction.

-        Pulmonary artery hypertension.

-        Associated aortic stenosis.

-        Associated mitral valve disease.

-        Hypovolemia.

What is the basis of Duroziez murmur

It is due to the exaggerated reversal of blood flow in diastole.