In the early stages of the condition, individuals with aortic regurgitation are typically asymptomatic. As aortic regurgitation develops gradually, symptoms may take years or even decades to manifest. When they do occur, symptoms include exertional dyspnea (i.e., shortness of breath upon exercise), orthopnea, (i.e., shortness of breath upon lying), paroxysmal nocturnal dyspnea (i.e., shortness of breath at night when the heart rate slows down), angina (i.e., chest pain), peripheral edema (i.e., swollen ankles and feet), fainting, a characteristic heart murmur, and palpitations. Sometimes, aortic regurgitation can occur acutely, typically as a result of an infection of the aortic valve, or pulmonary edema, where excess fluid is gathered in the lungs. Both can present with tachycardia (i.e., an increased heart rate) and tachypnea (i.e., an increased respiratory rate).
Clinical signs, also called peripheral signs of severe aortic regurgitation, are associated with the increase in the pulse pressure (approximately proportional to stroke volume), which is the difference between the systolic and diastolic blood pressures. As the blood regurgitates back into the left ventricle during diastole, the diastolic pressure in the aorta decreases, thereby leading to an increase in the pulse pressure. Additionally, the systolic blood pressure is often increased to compensate for the reduction in diastolic pressure, in an attempt to drive the forward flow of blood, which further widens the pulse pressure. Clinical signs of aortic regurgitation include the Becker sign, which is the visible pulsation of retinal arterioles via an ophthalmoscope; Corrigan pulse, which is a fast and forceful distension of the arterial pulse that collapses quickly; de Musset sign, which is when the head bobs with each heartbeat; Muller sign, which is the visible pulsation of the uvula; Quincke sign, which is the visible capillary pulsation at the root of the nail; Duroziez sign, which is a systolic and diastolic bruit (i.e., a sound that is heard when there is turbulence in the flow of blood) heard over the femoral artery when compressed; and Traube sign, which is a booming sound heard over the femoral artery. Other clinical signs include the Gerhardt sign, which is the detectable pulsations of the spleen in the presence of splenomegaly; Hill sign, where the blood pressure of the legs is greater than the blood pressure of the upper extremities; Rosenbach sign, which is the pulsation of the liver; Mayne sign, which is the drop in diastolic pressure of 15mm Hg upon the raising of the upper extremity above the head; and Landolfi sign, which when the pupil contracts during diastole and dilates during diastole. Finally, on auscultation by a healthcare provider, aortic regurgitation can be identified as a soft, high-pitched, early diastolic decrescendo murmur.
