Aortic Regurgitation

Leaking of blood back through the aortic valve. Patients often present with symptoms of breathlessness and then develop other symptoms of heart failure and can develop angina.




  • Collapsing/ Water hammer pulse
  • Wide pulse pressure (large difference between systolic and diastolic BP)
  • Cardiac Dilatation
  • Early-Diastolic murmur (often decrescendo in sound)
  • Numerous eponymous signs
    • De Musset’s sign: Head bobbing with pulse
    • Duroziers sign: Murmur heard over femoral arteries
    • Quinkes sign: visible pulsing of nail-bed capillaries




  • Acute AR: IE, aortic dissection, AVR failure, ruptured sinus of valsalva, acute rheumatic fever
  • Chronic AR: Bicuspid aortic valve, Marfans syndrome, syphilis (aortitis & AR) & seronegative arthritides (all HLA-B27 associated arthritides).




Bedside: O2 saturations, BP (? wide pulse pressure)

Bloods: FBC, U&E (baseline), CRP & ESR (raised in acute rheumatic fever), blood cultures (if querying IE), HLA-B27 for sero-negative arthritides. VRDL or TRPA (syphilis screen)

Functional: Echocardiogram

Invasive: Angiogram prior to any surgical replacement.




Conservative management is advised in asymptomatic patients

Valve replacement should be considered in patients with:

  • Acute AR which is moderate or severe
  • Chronic AR with NYHA class II or higher, breathlessness or angina.
  • Asymptomatic severe AR defined by: Significant aortic root dilatation, LV dilatation (LVEDD>70mm, LVESD>50mm) & EF<50%.



Written by Dr Thomas Craven


Resources used to write this document are listed in the references section of this webpage