MioAtlas
G1: Left-sided valves

Chronic aortic regurgitation

Chronic valvular aortic regurgitation characterized by progressive volume overload of the left ventricle due to diastolic backflow from the aorta across an incompetent aortic valve.

Open in 3D simulator

Definition

Chronic valvular aortic regurgitation characterized by progressive volume overload of the left ventricle due to diastolic backflow from the aorta across an incompetent aortic valve, inducing eccentric left ventricular hypertrophy, progressive ventricular dilation, and marked widening of the systemic arterial pulse pressure [V1] [V3].

Severity criteria

  • Mild (L): Regurgitant volume (RV) < 30 mL/beat; Regurgitant fraction (RF) < 30 %; Effective regurgitant orifice area (EROA) < 0.10 cm²; Pressure half-time (PHT) > 500 ms; vena contracta (VC) < 0.3 cm [V1] [V3].
  • Moderate (M): RV 30–59 mL/beat; RF 30–49 %; EROA 0.10–0.29 cm²; PHT 200–500 ms; vena contracta (VC) 0.3–0.59 cm [V1] [V3].
  • Severe (G): RV ≥ 60 mL/beat; RF ≥ 50 %; EROA ≥ 0.30 cm²; PHT < 200 ms; vena contracta (VC) ≥ 0.6 cm; holodiastolic flow reversal in descending aorta [V1] [V3].

Findings by layer

Hemodynamics

  • Regurgitant volume (RV) and regurgitant fraction (RF): Transaortic valvular quantification (RV < 30 mL, RF < 30% in mild; RV 30–59 mL, RF 30–49% in moderate; RV ≥ 60 mL, RF ≥ 50% in severe) [V1] [V3].
  • Blood pressure: Markedly wide pulse pressure in severe forms (systolic hypertension with very low diastolic, e.g., 123/23 mmHg) [V1] [V3].
  • Ventricular volumes: Progressive left ventricular dilation with marked increase in end-diastolic volume and elevated total cardiac output with preserved or decreased effective forward stroke volume in late stages [V1] [V3].

Rhythm

  • Normal sinus rhythm [V1].

ECG

  • Left ventricular hypertrophy due to volume overload (left ventricular hypertrophy voltage criteria, tall R waves with tall peaked positive T waves in precordial leads V5 and V6 in early stages, or systolic overload pattern with ST depression and T wave inversion in advanced stages) [E1] [V1].

Heart sounds and murmurs

  • Diastolic murmur: High-pitched, early diastolic decrescendo blowing murmur, auscultated with diaphragm at the 3rd left intercostal space / aortic area (site: aortic, pitch: high, shape: decrescendo) [V1] [V3] [G1-15].
  • Associated systolic murmur: Mid-systolic ejection aortic murmur due to transaortic volume hyperflow (functional flow murmur) [V3] [G1-14].
  • Austin Flint murmur: Apical low-frequency mid-diastolic rumble in severe forms due to displacement/vibration of the anterior mitral leaflet struck by the aortic regurgitant jet [V1] [V3] [G1-15].
  • Heart sounds: Soft A2 [G1-11] [V1]; third heart sound (S3) in advanced stages with LV dysfunction [G1-12] [V1].

Arterial pulse

  • In severe forms: Hyperdynamic, bounding, or collapsing pulse with rapid upstroke and swift collapse (pulsus celer et magnus / Corrigan pulse / water-hammer pulse) [B4] [V1].

Jugular venous pulse

  • Generally normal, unless advanced biventricular congestive heart failure supervenes [B3].

Maneuvers

  • Isometric handgrip: Increases peripheral vascular resistance and diastolic gradient [B1].
  • Squatting: Increases the diastolic murmur by raising afterload and preload [B1].
  • Valsalva (strain phase): Significantly decreases murmur intensity [B1].

Simulator severity grades

Simulator severity grades: Mild, Moderate, Severe
Baseline rhythm: Normal Sinus Rhythm

Also known as: Chronic aortic regurgitation · Aortic valve incompetence · Aortic regurgitation · Aortic insufficiency · AR

Other pathologies in this group

Related clinical comparisons

Sources

  1. [B1] Bedside diagnosis of systolic murmurs . N Engl J Med (1988) . DOI: 10.1056/NEJM198806163182404 PubMed: 2897627
  2. [B3] The jugular venous pressure revisited . Cleve Clin J Med (2013) . DOI: 10.3949/ccjm.80a.13039 PubMed: 24085809
  3. [B4] The Carotid Pulse . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250154
  4. [E1] AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology . Circulation (2009) . DOI: 10.1161/CIRCULATIONAHA.108.191097 PubMed: 19228820
  5. [G1-11] The Second Heart Sound . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250183
  6. [G1-12] The Third Heart Sound . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250184
  7. [G1-14] Systolic Murmurs . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250186
  8. [G1-15] Diastolic Murmurs . Clinical Methods: The History, Physical, and Laboratory Examinations (1990) . PubMed: 21250187
  9. [V1] 2025 ESC/EACTS Guidelines for the management of valvular heart disease . Eur Heart J (2025) . DOI: 10.1093/eurheartj/ehaf194 PubMed: 40878295
  10. [V3] Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance . J Am Soc Echocardiogr (2017) . DOI: 10.1016/j.echo.2017.01.007 PubMed: 28314623