Aortic regurgitation differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The differential diagnosis of aortic regurgitation includes other valvular abnormalities and diseases that can cause a similar clinical presentation.
Differential Diagnosis
The heart murmur of aortic regurgitation must be differentiated from that of other valvular diseases. Acute aortic regurgitation (AR) is characterized by the presence of a low pitched early diastolic murmur that is best heard at the right 2nd intercostal space, decreased or absent S1, and increased P2. Chronic AR is characterized by the presence of a high pitched holodiastolic decrescendo murmur that is best heard at the upper left sternal border and that increases with sitting forward, expiration, and handgrip.
The differential diagnosis of aortic regurgitation includes other valvular abnormalities:
- Aortic stenosis: The murmur of aortic stenosis is harsh and best heard at the right second intercostal space.
- Mitral regurgitation: The murmur of mitral regurgitation is blowing, soft and best heard at the apex.
- Mitral stenosis: The murmur of mitral stenosis is mid-diastolic, rumbling, and best heard after the opening snap.
- Tricuspid regurgitation: The murmur of tricuspid regurgitation is blowing, holosystolic, and best heard over the fourth intercostal area at the left sternal border.
- Tricuspid stenosis: The murmur of tricuspid stenosis is characterized by a mid diastolic murmur best heard over the left sternal border with rumbling character and tricuspid opening snap with wide splitting of S1.
Aortic regurgitation should also be differentiated from other diseases that might cause similar clinical presentation, such as:
- Acute coronary syndrome
- Anemia
- Heart failure
- Infective endocarditis
- Patent ductus arteriosus
- Pregnancy
- Thyrotoxicosis
- Volume depletion
- Wet beriberi