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Describe the heart sounds in aortic regurgitation

First heart sound (S1)
          Intensity of S1 is usually decreased, it is due to  the partial closure of mitral valve leaflet in presystole. It indicates that the aortic regurgitation is of moderate to severe intensity.
If the  patient has loud S1 – think of coexisting mitral stenosis.

Comment on the A2 in AR
          A2 is usually variable.
          Loud A2 is due to aortic root dilatation.
          Soft A- is produced due to low ability of valve leafet to vibrate after the aortic valve closure.
Describe the split in AR
          Split may be normal, single S2 or prodoxically split. 
What is the significance of S3 in AR
Occur in AR due to increased LVEDV (Left ventricular end diastolic volume). Left ventricular dysfunction can also  cause LVS3. LVS3 is commonly associated with Austin – flint murmur and peripheral signs of aortic regurgitation. 
What is the significance of S4 in AR
          Seen usually in severe AR.
What is the significance of Aortic ejection click in AR
1.    Seen in patients with mild AR with normal LV function.
2.    Valvular Ejection Click – is due to bicuspid aortic valve.
3.    Vascular ejection click– is due to Aortic root dilatation.