Syphilitic aortic valve regurgitation

Syphilis should be considered in a patient with aortic regurgitation and a chest radiograph that shows a dilated ascending aorta.

The distinguishing features of syphilitic aortic regurgitation are:

• a diastolic murmur which is often loudest at the right sternal edge (in contrast to the normal left sternal edge) because of the aortic dilatation
• an systolic snap due to rapid expansion of the aorta during systole

Aortic regurgitation may be well tolerated for many years. Eventually the volume overload of the left ventricle results in cardiac failure.