Synopsis
Distinguish acute from chronic aortic regurgitation, quantify severity and LV response, and act before irreversible ventricular dysfunction develops.
- Chronic AR produces LV volume overload, eccentric dilatation and a wide pulse pressure; symptoms can appear late after prolonged compensation.
- An early diastolic decrescendo murmur at the left sternal edge is typical; leaning forward in expiration can make it clearer.
- Acute severe AR may have a short, soft murmur and normal pulse pressure because the LV has had no time to dilate.
Key red flags
Sudden pulmonary oedema, hypotension and tachycardia after endocarditis, dissection, trauma or iatrogenic injury may occur without classic peripheral signs.
Investigation priorities
Define mechanism, quantify AR, measure LV size/function and examine the aortic root.
Management branches
Sudden severe AR causes pulmonary oedema, hypotension or shock.
- Use ABCDE care, continuous monitoring, urgent TTE/TOE and immediate cardiology, critical-care and cardiothoracic-surgical involvement.
- Search simultaneously for dissection, endocarditis, trauma or procedure complication; obtain blood cultures promptly if infection is plausible.
Key medicines
RamiprilFor hypertension, usually 2.5 mg orally once daily initially; use 1.25 mg once daily when the renin–angiotensin system is strongly activated, then titrate at 2–4-week intervals to a maximum 10 mg/day.
FurosemideFor chronic oedema, 40 mg orally in the morning is a usual initial adult dose; maintenance may be 20 mg daily or 40 mg on alternate days, adjusted to response.