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By: Ibrahim Machiwala
The natural history of AR is a slow and insidious disease process, with many patients remaining a symptomatic for decades. In a symptomatic patients, a cardiac murmur found during a routine medical examination often leads to diagnosis; however once cardiac symptoms develop, clinical deterioration is rapid.

• The principal symptoms associated with severe AR are exertional dyspnea, orthopnea, and paroxysmal noctumal dyspnea. These symptoms appear when pulmonary venous pressure is elevated in association with significant cardiomegaly and myocardial dysfunction. These changes occur late in the natural history of the disease.

• Angina pectoris may occur without CAD because coronary perfusion is inadequate to meet the demands of the enlarged and hypertrophic left ventricle. Less commonly, aortitis can involve the origion of the coronary arteries, leading to angina.

• Palpitation is a common complaint associated with a hyperdynamic and tachycardic left ventricle in significant AR Palpitation also may be due to frequent premature ventricular contraction.

• Syncope is an uncommon symptom associated with AR.

• Sudden cardiac deaths have been relatively rare in asymptomatic patients with normal LV funcation (

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