Clinical features of aortic incompetence

Aortic regurgitation is often asymptomatic because the left ventricle adapts to the increased stroke volume. Dyspnoea is a late feature indicating left ventricle failure.

Acute left ventricular failure is more common when the onset of aortic regurgitation is sudden, e.g. infective endocarditis, when the left ventricle has no time to adapt to the increase in workload.

Angina pectoris may occur and is often atypical; in syphilitic regurgitation where there is a narrowing of the coronary ostia.

Clinical features include:

• water-hammer pulse - wide pulse pressure
• pulse visible in the carotids - Corrigan's sign - plus a number of other eponymous signs
• JVP only raised if there is heart failure
• apex beat is displaced and volume overloaded:
  • typically there is dilatation of the left ventricle with relatively little hypertrophy
• early diastolic murmur:
  • blowing high pitched
  • starting immediately after A2, loudest at the 3rd and 4th intercostal spaces and also heard in the aortic area and at the apex
• ejection murmur:
  • loudest in the aortic area and goes to the carotid arteries
  • due to increased blood flow
• Austin Flint murmur:
  • low-pitched rumbling presystolic murmur
  • in severe cases may occur as a mid-diastolic murmur