Aortic regurgitation

Last reviewed: 26 Apr 2022
Last updated: 06 Jul 2021



History and exam

Key diagnostic factors

  • presence of risk factors
  • diastolic murmur
More key diagnostic factors

Other diagnostic factors

  • dyspnoea
  • fatigue
  • weakness
  • orthopnoea
  • paroxysmal nocturnal dyspnoea
  • pallor
  • mottled extremities
  • rapid and faint peripheral pulse
  • jugular venous distension
  • basal lung crepitations
  • altered mental status
  • urine output <30 mL/hour
  • soft S1
  • soft or absent A2
  • collapsing (water hammer or Corrigan's) pulse
  • cyanosis
  • tachypnoea
  • displaced, hyperdynamic apical impulse
  • chest pain
  • pink frothy sputum
  • wheeze (cardiac asthma)
  • additional heart sounds
  • arrhythmias
  • ejection systolic flow murmur
  • Austin Flint murmur
  • systolic thrill
  • Hill's sign
  • bisferiens pulse
  • de Musset's sign
  • Muller's sign
  • Traube's sign
  • Quincke's sign
  • Duroziez's sign
  • Mayen's sign
  • Lighthouse sign
  • Becker's sign
  • Landolfi's sign
  • Rosenbach's sign
  • Gerhardt's sign
  • Lincoln's sign
  • Sherman's sign
  • palmar click
  • syncope
Other diagnostic factors

Risk factors

  • bicuspid aortic valve
  • rheumatic fever
  • endocarditis
  • Marfan's syndrome and related connective tissue disease
  • systemic hypertension
  • aortitis
  • older age
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • CXR
  • echocardiogram
  • M-mode and 2-dimensional imaging
  • colour flow Doppler
  • pulsed wave Doppler
  • continuous wave Doppler
More 1st investigations to order

Investigations to consider

  • radionuclide angiography
  • MRI
  • exercise stress testing
  • cardiac catheterisation
More investigations to consider

Treatment algorithm


acute AR


mild to moderate chronic AR

severe chronic AR: asymptomatic with ejection fraction >50%

severe chronic AR: asymptomatic with ejection fraction ≤50%

severe chronic AR: symptomatic



Sanjeev Wasson, MD
Sanjeev Wasson

Medical Director

Department of Cardiology

Skagit Valley Hospital

Mount Vernon



SW declares that he has no competing interests.

Nishant Kalra, MD
Nishant Kalra

Associate Faculty Member

Department of Cardiology

University of Arizona




NK declares that he has no competing interests.

Peer reviewers

Kul Aggarwal, MD, MRCP, FACC, FACP

Professor of Clinical Medicine

University of Missouri-Columbia


Cardiology Section

Harry S. Truman Veterans Hospital




KA declares that he has no competing interests.

Rajdeep Khattar, DM, FRCP, FACC, FESC

Consultant Cardiologist and Honorary Senior Clinical Lecturer

Manchester Heart Centre

Central Manchester and Manchester Children's NHS Foundation Trust




RK declares that he has no competing interests.

John Pepper, MChir FRCS

Consultant Cardiac Surgeon

Department of Surgery

Royal Brompton Hospital




JP declares that he has no competing interests.

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  • Guidelines

    • 2018 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement: A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
    • 2017 ESC/EACTS guidelines for the management of valvular heart disease
    More Guidelines
  • Patient leaflets

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