{"id":271,"date":"2016-09-16T05:39:41","date_gmt":"2016-09-16T00:09:41","guid":{"rendered":"http:\/\/cardiophile.org\/?p=271"},"modified":"2022-05-11T13:47:37","modified_gmt":"2022-05-11T08:17:37","slug":"peripheral-signs-of-aortic-regurgitation","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/peripheral-signs-of-aortic-regurgitation\/","title":{"rendered":"Peripheral signs of aortic regurgitation"},"content":{"rendered":"<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/bXMY6Z5LU4Q\" title=\"YouTube video player\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen=\"\"><\/iframe><\/p>\n<h2><span style=\"color: #008000;\">Peripheral signs of aortic regurgitation<\/span><\/h2>\n<p><span style=\"color: #0000ff;\"><em><strong>Peripheral signs of AR<\/strong><\/em><\/span> are mostly due to the high stroke volume and high pulse pressure. They are noted in severe AR (free AR). These are features of aortic runoff and can occur in other situations of aortic runoff like a ruptured sinus of Valsalva into right atrium.<\/p>\n<ol>\n<li><span style=\"color: #0000ff;\">Arterial pulsations in the retina:<\/span> Normally there are only venous pulsations visible on the ocular fundus. In aortic regurgitation, retinal arterial pulsations are visible. This is known as <span style=\"color: #0000ff;\">Becker&#8217;s sign<\/span>.<\/li>\n<li><span style=\"color: #0000ff;\">Muller&#8217;s sign:<\/span> Systolic pulsations of the uvula in aortic regurgitation.<\/li>\n<li><span style=\"color: #0000ff;\">Dancing carotids:<\/span> Prominent carotid pulsations due to the wide pulse pressure in aortic regurgitation (<span style=\"color: #0000ff;\">Corrigan&#8217;s sign<\/span>).<\/li>\n<li><span style=\"color: #0000ff;\">de- Musset&#8217;s sign:<\/span> <span style=\"color: #0000ff;\">Head nodding sign<\/span> in aortic regurgitation.<\/li>\n<li><span style=\"color: #0000ff;\">Bisferiens pulse<\/span> is more suggestive of free aortic regurgitation than a combination of aortic stenosis and regurgitation. Bisferiens pulse has two peaks in each systole.<\/li>\n<li><span style=\"color: #0000ff;\">Locomotor brachii<\/span> is a prominent pulsation of brachial artery seen in aortic regurgitation. It can also be seen in elderly individuals without aortic regurgitation.<\/li>\n<li><span style=\"color: #0000ff;\">Collapsing pulse or water hammer pulse<\/span> is noted in the radial artery, with upper limb lifted up passively and felt by the palm of the hand. Water hammer was a toy in the Victorian era in which fall of water in vacuum tube produces a characteristic feel.<\/li>\n<li><span style=\"color: #0000ff;\">Quincke&#8217;s sign:<\/span> Prominent nail bed capillary pulsations.<\/li>\n<li><span style=\"color: #0000ff;\">Duroziez murmur \/ sign:<\/span> A stethoscope kept over the femoral artery picks up a systolic murmur with proximal compression and diastolic murmur with distal compression. The diastolic murmur is specific.<\/li>\n<li><span style=\"color: #0000ff;\">Pistol shot sounds<\/span> can be heard over the femoral arteries and sometimes over the brachial arteries (Traube&#8217;s sign).<\/li>\n<li><span style=\"color: #0000ff;\">Gerhardt&#8217;s sign:<\/span> Splenic pulsations in severe aortic regurgitation.<\/li>\n<li><span style=\"color: #0000ff;\">Rosenbach&#8217;s sign:<\/span> Hepatic pulsations in severe aortic regurgitation.<\/li>\n<li><span style=\"color: #0000ff;\">Mayne&#8217;s sign:<\/span> Exaggerated decrease in diastolic blood pressure (more than 15 mm Hg) on raising the upper limb. But the validity has been questioned as this can be noted in younger age without aortic regurgitation [1].<\/li>\n<li><span style=\"color: #0000ff;\">Lincoln sign:<\/span> Prominent popliteal artery pulsations.<\/li>\n<li><span style=\"color: #0000ff;\">Sherman sign:<\/span> Prominent dorsalis pedis artery pulsations.<\/li>\n<li><span style=\"color: #0000ff;\">Hill&#8217;s sign: <\/span>Hill&#8217;s sign [2] is based on the difference between the upper limb and lower limb arterial pressures recorded by the sphygmomanometer. Systolic pressure recorded from the lower limb is more than that from the upper limb. Difference in systolic pressure above 20 mm Hg is taken as significant. When Hill&#8217;s sign is taken for grading the severity of aortic regurgitation, the following classification is usually applied:<\/li>\n<\/ol>\n<p style=\"padding-left: 40px;\">Mild AR: 20 \u2013 40 mm Hg<br \/>\nModerate AR: 40 \u2013 60 mm Hg<br \/>\nSevere AR: More than 60 mm Hg<\/p>\n<p>It may be noted that direct intra arterial recordings of axillary and femoral arterial pressures did not demonstrate any exaggerated difference in systolic pressures between them [3]. Authors suggested that Hill&#8217;s sign is an artefact of sphygmomanometric lower limb pressure measurement and has no physiological basis.<\/p>\n<p><strong><span style=\"color: #0000ff;\">Cardio-ankle vascular index (CAVI)<\/span><\/strong><\/p>\n<p>Cardio-ankle vascular index (CAVI) [4], originally used to measure arteriosclerosis, has been used to assess AR objectively [5].&nbsp; CAVI measurement includes pulse pressure, difference between upper limb and lower limb pressures, ankle-brachial index, ejection time and upstroke time. Calculation of CAVI uses a complex formula [4]. Shiraishi H et al concluded that CAVI parameters could be useful in screening and serial follow up of patients with aortic regurgitation. <span style=\"font-size: inherit;\">This study also documented that Hill&#8217;s sign correlated with severity of AR [5]. Ankle brachial index increased in aortic regurgitation. Hill&#8217;s sign or difference between upper limb and lower limb pressures correlated semi-quantitatively with severity of AR.<\/span><\/p>\n<p><strong><span style=\"color: #0000ff;\">References<\/span><\/strong><\/p>\n<ol>\n<li>Happes M, Kamran H, Salciccioli L, Ko EH, Lazar JM. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20978434\">Mayne&#8217;s sign is mainly related to younger age and not to aortic regurgitation<\/a>. Blood Press Monit. 2010 Dec;15(6):305-7.<\/li>\n<li>Hill I, Flack M, Holtzmann W.&nbsp;The measurement of systolic blood pressure in man. Heart. 1909; 1: 73-82.<\/li>\n<li>Kutryk M, Fitchett D. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/9117911\/\">Hill&#8217;s sign in aortic regurgitation: enhanced pressure wave transmission or artefact?<\/a> Can J Cardiol. 1997 Mar;13(3):237-40.<\/li>\n<li>Shirai K, Utino J, Otsuka K, Takata M. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16733298\/\">A novel blood pressure-independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI)<\/a>. J Atheroscler Thromb. 2006 Apr;13(2):101-7.<\/li>\n<li>Shiraishi H, Shirayama T, Maruyama N, Kaimoto S, Otakara A, Kurimoto R, Nakanishi N, Nakamura T, Yamano T, Matsumuro A, Doi K, Yaku H, Matoba S. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27502315\/\">Usefulness of peripheral arterial signs in the evaluation of aortic regurgitation<\/a>. J Cardiol. 2017 May;69(5):769-773.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Peripheral signs of aortic regurgitation (AR) are mostly due to the high stroke volume and high pulse pressure. These are features of aortic run off and can occur in other situations of aortic run off like a ruptured sinus of Valsalva into right atrium.<\/p>\n","protected":false},"author":1,"featured_media":53593,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[25,8,9],"tags":[],"class_list":["post-271","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-echocardiogram-library-echocardiogram-library","category-echocardiogram-library","category-general"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Peripheral signs of aortic regurgitation - 15 named signs<\/title>\n<meta name=\"description\" content=\"Peripheral signs of aortic regurgitation - 15 named signs - most of them are due to the aortic run off and high stroke volume with vasodilatation.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/peripheral-signs-of-aortic-regurgitation\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Peripheral signs of aortic regurgitation - 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