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# Aortic regurgitation

Aortic regurgitation is a leak of the aortic valve: after each beat some blood flows backward from the aorta into the [left ventricle](https://durgical.com/en/anatomy/left-ventricle/).

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Aortic right coronary cusp](https://durgical.com/en/anatomy/right-coronary-leaflet/)
- [Aortic left coronary cusp](https://durgical.com/en/anatomy/left-coronary-leaflet/)
- [Aortic non-coronary cusp](https://durgical.com/en/anatomy/non-coronary-leaflet-of-aortic-valve/)
- [Ascending aorta](https://durgical.com/en/anatomy/ascending-aorta/)
- [Left ventricle](https://durgical.com/en/anatomy/left-ventricle/)
- [Valve rings (fibrous skeleton)](https://durgical.com/en/anatomy/fibrous-rings-of-the-heart-valves/)
- [Aortic arch](https://durgical.com/en/anatomy/aortic-arch/)
- [Mitral anterior leaflet](https://durgical.com/en/anatomy/anterior-leaflet-of-left-atrioventricular-valve/)

## In the clinical exam

- [Cardiac auscultation: the areas and the order](https://durgical.com/en/clinical-exam/cardiac-auscultation-the-areas-and-the-order/)
- [Valve murmurs: the table to know](https://durgical.com/en/clinical-exam/valve-murmurs-the-table-to-know/)
- [Dynamic auscultation: Valsalva, squatting, standing and handgrip](https://durgical.com/en/clinical-exam/dynamic-auscultation-valsalva-squatting-standing-and-handgrip/)
- [Abnormal pulses: paradoxus, alternans, parvus et tardus, bounding](https://durgical.com/en/clinical-exam/abnormal-pulses-paradoxus-alternans-parvus-et-tardus-bounding/)
- [Arterial pulse: rate, rhythm and amplitude](https://durgical.com/en/clinical-exam/arterial-pulse-rate-rhythm-and-amplitude/)

## In physiology

- [The ventricular pressure–volume loop](https://durgical.com/en/physiology/the-ventricular-pressure-volume-loop/)
- [Systolic, diastolic, mean and pulse pressure](https://durgical.com/en/physiology/systolic-diastolic-mean-and-pulse-pressure/)
- [Murmurs and the hemodynamics of valve disease](https://durgical.com/en/physiology/murmurs-and-the-hemodynamics-of-valve-disease/)

## Why it happens

- [Hypertrophy: physiologic and pathologic](https://durgical.com/en/general-pathology/hypertrophy-physiologic-and-pathologic/)

## What it is

Backflow of blood from the aorta into the left ventricle during diastole because the aortic valve does not close properly.

## Who gets it

Less common than aortic stenosis or mitral regurgitation. Rheumatic disease remains a relevant cause in Colombia and Latin America; elsewhere, bicuspid valves and aortic root dilation predominate.

## Causes

- Valve leaflet disease: bicuspid aortic valve, rheumatic heart disease, infective endocarditis
- Aortic root dilation: hypertension, Marfan syndrome, ageing
- Aortic dissection involving the root (acute)
- Inflammatory aortitis: ankylosing spondylitis, tertiary syphilis

## Risk factors

- Bicuspid aortic valve
- Previous rheumatic fever
- Long-standing hypertension
- Connective tissue disease
- Infective endocarditis
- Untreated syphilis

## Pathophysiology

Regurgitant blood adds to normal filling, creating a combined volume and pressure load. In chronic disease the left ventricle dilates and hypertrophies, keeping output with a large stroke volume, which widens the pulse pressure. Eventually the ventricle fails. In acute disease the ventricle cannot adapt and pulmonary oedema and shock follow.

## Classification

- Acute vs chronic
- Leaflet disease vs aortic root disease
- Severity: mild, moderate or severe by echocardiography

## Symptoms and signs

- Often no symptoms for many years
- Exertional breathlessness, orthopnoea and fatigue
- Palpitations or awareness of the heartbeat
- Early diastolic decrescendo murmur at the left sternal border, louder sitting forward in expiration
- Wide pulse pressure with a bounding, collapsing (water-hammer) pulse
- Head bobbing and visible arterial pulsations in severe chronic disease

## Red flags

- Sudden breathlessness or shock (acute regurgitation)
- Tearing [chest](https://durgical.com/en/anatomy/region/chest/) or back pain suggesting aortic dissection
- Fever with a new diastolic murmur (endocarditis)
- Angina or a rising left ventricular size on follow-up

## Diagnosis

**Clinical**
Suggested by the diastolic decrescendo murmur and wide pulse pressure; peripheral signs reflect the large stroke volume.

**Tests**
ECG may show left ventricular hypertrophy. Blood cultures if endocarditis is suspected; syphilis serology when relevant.

**Imaging**
Echocardiography confirms the mechanism and severity and measures ventricular size and function and the aortic root. CT or MRI assesses the aorta; CT angiography is urgent if dissection is suspected.

## Differential diagnosis

- Pulmonary regurgitation
- Mitral stenosis
- Patent ductus arteriosus
- Aortic dissection
- High-output states such as anaemia or hyperthyroidism

## Goal of treatment

Monitor and replace the valve before irreversible left ventricular damage, control blood pressure and treat the aorta and the cause.

## Treatment

**Follow-up**
Regular echocardiographic follow-up of ventricular size and function in asymptomatic patients.

**Medical**
Blood pressure control with vasodilators such as ACE inhibitors, ARBs or dihydropyridine calcium channel blockers; heart-failure drug classes when surgery is not possible.

**Surgical**
Aortic valve replacement (or repair) for severe symptomatic disease or ventricular dysfunction or dilation; aortic root surgery when dilated.

**Acute**
Emergency surgery for acute regurgitation, for example from dissection or endocarditis.

## Complications

- Heart failure
- Infective endocarditis
- Ventricular arrhythmias
- Aortic dissection in root disease

## Prognosis

Chronic aortic regurgitation can stay stable for many years. Once symptoms or ventricular dysfunction appear, outcome worsens without surgery. Acute regurgitation is a surgical emergency.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the typical murmur of aortic regurgitation?

An early diastolic, high-pitched decrescendo murmur at the left sternal border, best heard sitting forward in full expiration.

## Why is the pulse pressure wide in chronic aortic regurgitation?

A large stroke volume raises systolic pressure, while backflow into the ventricle lowers diastolic pressure.

## What is a water-hammer (Corrigan) pulse?

A bounding pulse that rises and collapses rapidly, typical of chronic aortic regurgitation.

## Which acute cause of aortic regurgitation is a vascular emergency?

Type A aortic dissection extending into the aortic root.

## Which two conditions commonly dilate the aortic root and cause regurgitation?

Marfan syndrome and long-standing hypertension; aortitis from syphilis or ankylosing spondylitis is also possible.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/aortic-regurgitation/)

## Related conditions

- [Aortic dissection](https://durgical.com/en/conditions/aortic-dissection/)
- [Infective endocarditis](https://durgical.com/en/conditions/infective-endocarditis/)
- [Rheumatic heart disease](https://durgical.com/en/conditions/rheumatic-heart-disease/)
- [Aortic Valve Stenosis](https://durgical.com/en/conditions/aortic-valve-stenosis/)
- [Heart failure](https://durgical.com/en/conditions/heart-failure/)
- [Syphilis](https://durgical.com/en/conditions/syphilis/)
- [Coarctation of the aorta](https://durgical.com/en/conditions/coarctation-of-the-aorta/)
- [Patent ductus arteriosus](https://durgical.com/en/conditions/patent-ductus-arteriosus/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Aortic Insufficiency](https://www.ncbi.nlm.nih.gov/books/NBK557428/) (StatPearls (NCBI Bookshelf), 2023).

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Source: https://durgical.com/en/conditions/aortic-regurgitation/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/aortic-regurgitation/