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Owing to the ability of the powerful left ventricle to deal with the reflux of blood which occurs in diastole compensation may be excellent for many years. In time left ventricular failure occurs and progressive dyspnoea on exertion is soon followed by paroxysmal dyspnoea at rest, orthopnoea and finally congestive cardiac failure. The characteristic and most important sign of aortic incompetence is a high-pitched blowing early diastolic murmur commencing immediately after the second heart sound and best heard down the left sterna edge with the patient standing or sitting and the left sterna edge with the patient standing or sitting and the breath held in expiration. A blowing systolic murmur is a common accompaniment. Collapsing or water –hammer radial pulse. There is an abrupt upstroke with sudden impact against the examining finger and a rapid falling away or collapse. Associated peripheral vasodilatation gives rise to pink and warm extremities and to capillary pulsation, e.g. in the nail beds. Radiography will show the degree of left ventricular enlargement and the electrocardiogram may show the pattern of left ventricular hypertrophy.