1. SIGNS OF AORTIC REGURGITATION
Signs of wide pulse pressure :
• Light house sign - alternate flushing and blanching of forehead
• Landolfi's sign - change in pupillary size in accordance with cardiac cycle
• Becker's sign - retinal artery pulsations
• de Musset's sign - head bobbing with each heart beat
• Muller's sign - systolic pulsations of uvula
• Quincke's sign - capillary pulsations, detected by pressing a glass slide on patients lip or nail bed
• Corrigan's sign - dancing carotids
• Locomotor brachii
• Collapsing pulse - systolic pressure & diastolic pressure; but systolic > diastolic
• Pulsus bisferiens - double peaking in single systole
• Traube's sign - pistol shot femorals
• Duroziez s sign - proximal compression - systolic murmur over femoral artery
Distal compression with diaphragm of the stethoscope - diastolic murmur (Duroziez murmur)
• Hill's sign - popliteal cuff systolic pressure exceeds brachial cuff pressure by >20 mm Hg.
Mild AR - 20-40 mm Hg
Moderate AR - 40- 60 mm Hg 1
Severe AR - > 60 mm Hg
• Rosenbach’s-sign - pulsations of liver
• Gerhardt’s sign - pulsations of spleen
• Other Signs:
Apical impulse displaced down and out ; hyper dynamic
Soft S1 (only in acute AR) ; S3 may be heard
Early diastolic murmur - high frequency, decrescendo; in left 3rd
& 4th
spaces with diaphragm of the stethoscope with
the patient leaning forwards, in expiration
Flow EDM across aortic valve heard at the heart base, conducted to carotids
Flow MDM across mitral valve (Austin-Flint murmur)- no loud S1 or opening snap unlike mitral stenosis
Severity of the lesion is indicated by:
a. Duration of murmur - if murmur > two thirds of diastole – murmur becomes holodiastolic & rough in quality
b. Bisferiens pulse
c. Positive Hill's sign > 60 mm Hg.
d. Apical impulse (down and out)
e. Austin-Flint murmur
f. Marked peripheral signs
