We have reviewed a case of chronic aortic regurgitation that is severe. But this disease may also occur on an acute basis, trauma to the chest, acute infectious endocarditis, and when than happens, the findings at the bedside are different, and the reason is there is no time for compensatory mechanisms to occur. Therefore, there may not be time for the peripheral vasodilatation that occurs in chronic aortic regurgitation, hence the pulse pressure may not be wide. The pulse, when you feel it, not only the blood pressure, but the pulse itself may not be rapid rising, not bifid, not a rapid collapse. Then you go to feel the chest wall, and there is no time for that ventricle to slowly but surely dilate over time. Therefore, it is not inferolaterally displaced and enlarged, but rather, it is in the normal position. And finally, when you listen, there is no time for that ventricle to accommodate for that gush of blood back into the ventricle. Therefore, instead of the murmur being long [sounds] it’s much shorter, [sounds], because that ventricle is tight, it’s not as compliant as a giving ventricle that’s been stretched over time and, therefore, the pressure rises very rapidly in the ventricle when the aortic regurgitation occurs and that reduces the length of the murmur.
So, there are rules to determine the difference between the acute type of aortic regurgitation and the chronic. They are very useful. This was chronic, but beware the findings may be different in a patient with acute aortic regurgitation.