What are the key clinical features to assess in a patient suspected of having aortic regurgitation?

When assessing a patient suspected of having aortic regurgitation, key clinical features to evaluate include both symptoms and physical signs indicative of the condition. Symptomatically, patients may present with breathlessness, particularly on exertion or at rest, angina, fatigue, and in advanced cases, signs of heart failure such as peripheral oedema. It is important to enquire about exertional syncope as well, which may indicate more severe valve disease NICE NG208.

On physical examination, the presence and nature of a murmur are critical. Aortic regurgitation typically produces a high-pitched, early diastolic decrescendo murmur best heard at the left sternal edge with the patient sitting forward. Additionally, signs such as a bounding pulse, wide pulse pressure, and a displaced apex beat may be observed. The second heart sound may be reduced or absent due to valve leaflet pathology NICE NG208.

Electrocardiogram abnormalities and evidence of left ventricular dilation or dysfunction on echocardiography are also important clinical features to assess, as they reflect the haemodynamic impact of regurgitation and guide management decisions NICE NG208. Echocardiography remains the cornerstone for confirming diagnosis and assessing severity, including left ventricular ejection fraction and end-systolic dimensions, which are prognostically significant Victor et al. 2025.

Recent literature emphasizes a comprehensive clinical assessment integrating detailed auscultation with echocardiographic evaluation to quantify regurgitation severity and ventricular response, which is essential for timely referral and intervention Walpot et al. 2021Victor et al. 2025.