What are the physical exam findings in chronic aortic regurgitation (AR)?

Updated: Nov 19, 2018
  • Author: Stanley S Wang, JD, MD, MPH; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

On palpation, the point of maximal impulse may be diffuse or hyperdynamic but is often displaced inferiorly and toward the axilla. Peripheral pulses are prominent or bounding. Auscultation may reveal an S3 gallop if LV dysfunction is present.

The murmur of AR occurs in diastole, usually as a high-pitched sound that is loudest at the left sternal border. The duration of the murmur correlates better with the severity of AR than does the loudness of the murmur. A functional systolic flow murmur may also be present because of increased stroke volume, although concurrent aortic stenosis may also be present. [5]

An Austin-Flint murmur may be present at the cardiac apex in severe AR; it is a low-pitched, mid-diastolic rumbling murmur due to blood jets from the AR striking the anterior leaflet of the mitral valve, which results in premature closure of the mitral leaflets.

In many cases, physical examination also reveals findings relating to the underlying cause of AR. For example, there may be various embolic phenomena in patients with AR due to infective endocarditis, or the patient may have skeletal features suggestive of Marfan syndrome or a spondyloarthropathy if AR is due to these conditions.


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