Case history
Case history #1
A 55-year-old white man presents with weakness, palpitations, and dyspnea on exertion. On physical exam, his blood pressure is 148/50 mmHg with a bounding pulse and an early diastolic murmur over the left sternal border. He denies any history of drug abuse, rheumatic fever, or connective tissue disorder. The patient is taking hydrochlorothiazide for high blood pressure. Echocardiography reveals a left ventricular ejection fraction (LVEF) of 55%, left ventricular end-diastolic diameter of 70 mm, and end-systolic diameter of 50 mm.
Case history #2
A 31-year-old black man presents to clinic for the first time for a routine physical exam. He denies any complaints. On physical exam the only abnormality is a systolic murmur best heard over the second right intercostal space and an early diastolic murmur best heard over the third left sternal border. LVEF is 55% to 60% with mild LV hypertrophy. Left ventricular end-systolic diameter is 45 mm and aortic root diameter is 3.5 cm.
Other presentations
In acute AR, patients can present with sudden onset of pulmonary edema and hypotension or in cardiogenic shock. Patients may also present with signs and symptoms of myocardial ischemia or aortic root dissection.[1] Due to the acute nature of the AR, there may be no increase in left ventricular size, and the diastolic murmur may be short and/or soft due to diastolic pressure equilibrium between aorta and ventricle occurring before the end of diastole. Pulse pressure may not be increased due to reduced systolic pressure.[2]
Use of this content is subject to our disclaimer