Features of severe aortic incompetence

Severe aortic incompetence is suggested by the presence of one or more of the following clinical features:
1. Short early diastolic murmur (diastolic pressure in the left ventricle rapidly approaches that in the aorta)
2. Wide pulse-pressure
3. Displaced, hyperdynamic apex beat - implying significant volume overload.

The Austin-Flint murmur may be heard in aortic incompetence (fluttering of the anterior mitral valve leaflet due to turbulance from the regurgitant jet). Whilst a normal heart size on chest radiograph does not preclude a diagnosis of severe aortic incompetence (e.g. acute), it is far more commonly enlarged.