Page 132 - Clinical Pearls in Cardiology

120 Clinical Pearls in Cardiology

29. How will you differentiate rheumatic AR from
syphilitic AR?
Some important points that help differentiate rheumatic
aortic regurgitation from syphilitic aortic regurgitation
are the following (Table 4):
Table 4: Difference between rheumatic AR and syphilitic AR
Rheumatic AR Syphilitic AR
Age Usually in younger age Usually in elderly
Symptoms Angina pain less Anginal pain more
common common
A2 Soft Loud and tambour
like
Murmur Best heard in the aortic Best heard in 3rd right
area or in the Erb’s area intercostal space and
(3rd left intercostal radiates along the
space) right sternal border
Valve Usually multivalvular Isolated involvement
involvement

30. What are the important peripheral signs of aortic
regurgitation?
The presence of peripheral signs indicates a severe
degree of aortic regurgitation. The important peripheral
signs of aortic regurgitation are the following:
• Collapsing pulse—also called as water-hammer or
Corrigan’s pulse. This is a high volume pulse with
rapid upstroke and rapid downstroke (Fig. 2).
Raising the patient’s arm higher than the level of the
heart reduces the intraradial diastolic pressure and
collapses the vessel. This facilitates the better
palpability of the subsequent systolic thrust.