Aortic Regurgitation: Key Peripheral Signs and Underlying Causes

By SWA

Introduction:

Aortic regurgitation (AR), or Aortenklappeninsuffizienz, is a condition in which the aortic valve does not close properly during diastole, allowing blood to flow backward from the aorta into the left ventricle. This backflow creates several hemodynamic changes in the body and is associated with a number of classic peripheral signs that are particularly noticeable in cases of chronic severe aortic regurgitation. Below, we outline five key peripheral signs that help in recognizing this condition, followed by a review of its common causes.

Five Peripheral Signs of Aortic Regurgitation

  1. Quincke's sign:
    This sign presents as alternating blushing and blanching of the nailbeds with each heartbeat. It is a sign of capillary pulsation and is most easily observed by applying gentle pressure to the nailbed while using a light source to enhance visibility. This phenomenon results from the large stroke volume and increased pulse pressure associated with aortic regurgitation.
    Learn more about Quincke's sign in aortic regurgitation here.

  2. Corrigan pulse (Water-hammer pulse):
    A bounding and forceful pulse that rapidly collapses is known as Corrigan pulse or a "water-hammer" pulse. This occurs due to the increased stroke volume and the rapid emptying of the arteries during diastole when blood leaks back into the left ventricle.
    You can read more about Corrigan pulse here.

  3. de Musset sign:
    Head bobbing that is synchronous with the heartbeat is called de Musset sign. This is a result of the large volume of blood flowing back into the left ventricle, which causes noticeable pulsations throughout the body, including the head.
    Detailed information on de Musset sign can be found here.

  4. Müller sign:
    Pulsation of the uvula is another peripheral sign of aortic regurgitation. Like other signs, this reflects the heightened pulse pressure and can be observed during an oral examination.
    Explore more about Müller sign in AR here.

  5. Becker sign:
    Visible pulsation of the retinal arteries when viewed with an ophthalmoscope is known as Becker sign. This is a direct result of the increased stroke volume and pulse pressure associated with severe AR.
    You can read more about Becker sign here.

These physical signs are typically present in cases of chronic, severe aortic regurgitation and indicate significant hemodynamic changes that are characteristic of this condition.

Causes of Aortic Regurgitation

Aortic regurgitation can develop from a variety of underlying conditions, which affect either the valve itself or the structures supporting it. Here are some of the most common causes:

1. Degenerative Changes

Over time, the aortic valve can suffer from age-related wear and tear, leading to stiffening or calcification. This prevents the valve from closing properly, allowing blood to leak backward into the ventricle.
Learn more about degenerative causes of aortic regurgitation here.

2. Congenital Heart Defects

Bicuspid aortic valve disease is one of the most common congenital heart defects associated with aortic regurgitation. In this condition, the aortic valve has two leaflets instead of three, which can lead to premature dysfunction.
More information on bicuspid aortic valve and AR can be found here.

3. Rheumatic Heart Disease

Rheumatic fever, often a result of untreated strep throat infections, can cause chronic inflammation, leading to scarring and deformation of the aortic valve. This increases the risk of regurgitation over time.
Read more about rheumatic heart disease and its impact on the valves here.

4. Endocarditis

Infective endocarditis can damage the valve leaflets through infection, leading to a perforated or dysfunctional valve. Bacteria or fungi infect the valve, making it unable to seal the aortic orifice completely.
For more information on endocarditis and valve dysfunction, click here.

5. Aortic Root Dilation

Enlargement of the aortic root, the part of the aorta connected to the heart, can pull apart the valve leaflets and prevent proper closure. This can occur in conditions such as Marfan syndrome, aortic aneurysm, or aortic dissection.
Find more on aortic root dilation and its connection to AR here.

6. Trauma or Injury

A severe chest injury or trauma can damage the aortic valve or its supporting structures, resulting in regurgitation. This is a rare but serious cause of AR.

7. Chronic Hypertension

High blood pressure over a prolonged period can cause the aortic root to dilate, eventually affecting the function of the aortic valve and leading to regurgitation.
More on hypertension and its effects on the heart can be found here.

Conclusion

Aortic regurgitation is a condition characterized by the backflow of blood from the aorta into the left ventricle due to improper closure of the aortic valve. Over time, this leads to reduced blood flow to the body and a reduced oxygen supply, especially during exertion. The result is symptoms such as physical exhaustion, tiredness, shortness of breath (dyspnea) and reduced performance. These symptoms result from the inadequate oxygen supply to the tissue, as the heart can no longer pump effectively due to the valve insufficiency.
It presents with several classic peripheral signs such as Quincke's sign, Corrigan pulse, de Musset sign, Müller sign, and Becker sign, which are typically seen in severe cases. A variety of conditions can lead to aortic regurgitation, including degenerative changes, congenital defects, rheumatic heart disease, endocarditis, aortic root dilation, trauma, and chronic hypertension. Early diagnosis and management are key to preventing the progression of the disease and avoiding complications like heart failure.

 

© 2000-2025 Sieglinde W. Alexander. All writings by Sieglinde W. Alexander have a fife year copy right.
Library of Congress Card Number: LCN 00-192742
ISBN: 0-9703195-0-9

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