Aortic Incompetence

Question 1

Clinical signs of aortic incompetence

Answer 1

Collapsing pulse (water hammer)
Wide pulse pressure
Apex displaced laterally 
Thrill in aortic area
Characteristic murmur
Eponymous signs

Question 2

Eponymous signs in aortic regurgitation

Answer 2

Corrigan’s: visible vigorous neck pulsation
Quincke’s: visible pulsation in nail bed
De Musset’s: head nodding
Duroziez’s: diastolic murmur proximal to femoral compression
Traube’s: pistol shot murmur in femoral artery

Question 3

Murmur in aortic regurgitation

Answer 3

Early diastolic murmur heard loudest at lower left sternal edge in held expiration with patient sat forward
May have mid diastolic murmur due to impaired mitral valve opening
In severe AR murmurs may become silent

Question 4

Congenital causes of aortic regurgitation

Answer 4

Bicuspid valve

Perimembranous VSD

Question 5

Acquired causes of AR

Answer 5

Valve leaflets: endocarditis, rheumatic fever, drugs e.g. pergolide, slimming agents
Aortic root: dissection, trauma. Dilatation - Marfans, hypertension. Aortitis - syphilis, ankylosing spondylitis, vasculitis.

Question 6

DDx of hyper dynamic (collapsing) pulse

Answer 6

AR
Pregnancy
Anaemia
PDA

Question 7

Medical treatment of AR

Answer 7

ACEI or ARB (reduce afterload)

Question 8

Indications for surgical intervention in AR

Answer 8

Acute:
Dissection
Aortic root abcess/endocarditis

Chronic:
Replace valve when
1. Symptomatic dyspnoea and reduced exercise tolerance (NYHA>II) and/or
2. Specific criteria