Aortic Regurgitation:
Please examine the Cardiovascular System of this 55 year old gentleman who
presents with dyspnoea.
Clinical Examination:
Classical Signs
- Large volume, collapsing pulse
- Head nodding in t with heart beat
(de Musset’s sign)
- Visible carotid pulsations
(Corrigan’s signs)
- Capillary pulsation in fingernails
(Quincke’s sign)
- Pistol shot femorals (Traube’s sign)
- Displaced, thrusting apex beat
- Early diastolic, high-pitched,
rumbling murmur at left sternal edge
with patient sitting forwards in
expiration
- Investigations and Management
Quick Revision:
Differential: Pulmonary regurgitation – but this would be louder in inspiration
Aetiology:
- Infective endocarditis
- Rheumatic heart disease
- Ankylosing spondylitis
- Rheumatoid arthritis
- Marfan’ syndrome
- Prosthetic valve paravalvular
leak
- Treponemal disease
Additional Signs
- Stigmata of Marfan’s
syndrome, ankylosing
spondylitis, rheumatoid
arthritis
- Mid-diastolic murmur
(Austin-Flint) heard at the
apex
- Ejection systolic murmur in
severe aortic regurgitation
- Signs of infective
endocarditis
Common discussion topics:
- Diagnosis and differentials
- Symptoms and signs of severity
Management
- Vasodilators (Nifedipine) delay surgery
- Surgery may be indicated when: LVEF
<30% but > 50% or LVESD > 55mm
- Signs of severity:
- Wide pulse pressure
- Soft S2, S3 may be heard
- Left ventricular failure
- Hill’s sign – BP in legs > arms
- Austin-Flint murmur