Aortic Regurgitation - Peripheral Signs

The peripheral signs of aortic regurgitation are mostly due to the high-flow state, large stroke volume and wide pulse pressure seen in aortic regurgitation.

In 19th century Europe, the infection syphilis was widespread. Syphilitic aortitis, resulting in aortic root dilation and severe aortic valve regurgitation, was quite common. With no good therapy — medical or surgical — available during that period, the disease was allowed to progress; many individuals developed severe congestive heart failure from the aortic valve regurgitation. This resulted in physical examination findings described by multiple physicians, attempting to diagnose aortic regurgitation as the cause of an individual’s congestive heart failure.

Many peripheral signs of aortic regurgitation have been identified and named after the physician that first described it; they are listed below. The sensitivity of these findings are low. While intellectually and historically interesting, they are not always clinically useful.

• Corrigan’s pulse: A rapid and forceful distension of the arterial pulse with a quick collapse
• De Musset’s sign: Bobbing of the head with each heartbeat (like a bird walking)
• Muller’s sign: Visible pulsations of the uvula
• Quincke’s sign: Capillary pulsations seen on light compression of the nail bed
• Traube’s sign: Systolic and diastolic sounds heard over the femoral artery (“pistol shots”)
• Duroziez’s sign: Gradual pressure over the femoral artery leads to a systolic and diastolic bruit
• Hill’s sign: Popliteal systolic blood pressure exceeding brachial systolic blood pressure by ≥ 60 mmHg (most sensitive sign for aortic regurgitation)
• Shelly’s sign: Pulsation of the cervix
• Rosenbach’s sign: Hepatic pulsations
• Becker’s sign: Visible pulsation of the retinal arterioles
• Gerhardt’s sign (aka Sailer’s sign): Pulsation of the spleen in the presence of splenomegaly
• Mayne’s sign: A decrease in diastolic blood pressure of 15 mmHg when the arm is held above the head (very non-specific)
• Landolfi’s sign: Systolic contraction and diastolic dilation of the pupil

In acute AR, the above listed peripheral signs are absent, as the heart does not have time to compensate for the increased LV volume. Additionally, the murmur of aortic regurgitation is short in duration and may be difficult to hear with the aortic pressure and the LV pressure (which is elevated in acute AR) equalizing quickly in diastole. A soft first heart sound may be present, due to early closure of the mitral valve.