Page 131 - Clinical Pearls in Cardiology

Valvular Heart Diseases 119

of Korotkoff sounds (i.e. phase 4 of Korotkoff sounds) as
the indicator of diastolic blood pressure in subjects with
aortic regurgitation.
The lower limb blood pressure is also important
in a patient with aortic regurgitation. The lower limb
blood pressure (taken by indirect method using cuff) is
higher than the upper limb blood pressure by more than
20 mm Hg in a person with aortic regurgitation (i.e.
positive Hill sign).
28. What are the clinical signs of severe aortic regurgita-
tion?
The clinical signs of severe aortic regurgitation are the
following:
• Gross cardiomegaly
• Waterhammer pulse
• Diastolic blood pressure less than 50 mm Hg
• Hill sign positivity by more than 60 mm Hg
• Presence of other peripheral signs of AR
• Long decrescendo diastolic murmur in the aortic area.
• Midsystolic flow murmur in the aortic area radiating
to the carotids. This flow murmur has the same
quality as the murmur of organic aortic stenosis.
However, the presence of gross cardiomegaly and
peripheral signs of aortic regurgitation helps to
differentiate this murmur from that due to aortic
stenosis.
• Soft mid-diastolic apical murmur (Austin-Flint
murmur): The regurgitant jet causes fluttering and
partial closure of the anterior mitral leaflet. This
renders the mitral valve functionally stenotic, and
produces the murmur.