Diagnosis - Discussion
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Aortic Regurgitation History

The diagnosis of severe aortic regurgitation due to a congenital valve defect is supported by the patient’s history of a murmur since childhood, systolic hypertension, and prominent carotid arterial neck pulsations. Dyspnea on exertion, paroxysmal nocturnal dyspnea and night sweats offer evidence that the lesion is severe.

Physical Examination

His physical examination demonstrated a wide pulse pressure, a rapidly rising bifid carotid arterial pulse with prominent peripheral pulses, an enlarged inferolaterally displaced left ventricle, and the typical murmurs of severe aortic regurgitation.

Etiologies of Chronic Aortic Regurgitation

The most common etiologies of chronic aortic regurgitation include a congenital bicuspid aortic valve, rheumatic aortic valve disease, post infective endocarditis and aortic root disease. In our patient, a history and physical findings, particularly the ejection sound, are most consistent with a congenital etiology.