Aortic regurgitation

Last reviewed: 28 Dec 2022
Last updated: 15 Jul 2022



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
  • chest x-ray
  • 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


chronic AR: mild to moderate

chronic AR: severe, asymptomatic

chronic AR: severe, symptomatic



Poorna R. Karuparthi, MD, FACC

Associate Professor of Medicine

University of Missouri-Columbia

Chief of Cardiology

Harry S. Truman Veterans' Hospital




PRK declares that he has no competing interests.


Dr Poorna R. Karuparthi would like to gratefully acknowledge Dr Sanjeev Wasson and Dr Nishant Kalra, previous contributors to this topic.


SW and NK declare that they have 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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