Expansion
A wide pulse pressure produces a long list of eponyms
Expansion
The murmur: early diastolic, decrescendo, at the left sternal edge, best heard sitting forward in expiration. An Austin Flint mid-diastolic murmur at the apex indicates severe regurgitation.
The eponyms, all produced by the wide pulse pressure
- Corrigan’s sign - visible carotid pulsation
- Water hammer (collapsing) pulse - felt with the arm raised
- de Musset’s sign - head nodding with each beat
- Quincke’s sign - capillary pulsation in the nail bed
- Traube’s sign - a “pistol shot” sound over the femoral artery
- Duroziez’s sign - a to and fro murmur over the compressed femoral artery
- Muller’s sign - pulsation of the uvula
“One lesion, seven eponyms, one mechanism.”
Causes split by where the problem lies:
- Valve: rheumatic disease, bicuspid valve, endocarditis, connective tissue disease
- Root: Marfan’s, aortic dissection, ankylosing spondylitis, syphilis, aortitis
Acute aortic regurgitation behaves completely differently: the ventricle has not dilated, so there is no wide pulse pressure and no eponyms, but there is sudden pulmonary oedema and cardiogenic shock. It is a surgical emergency, most often from dissection or endocarditis.