Internal Medicine

P1: SBT

0521779407-04 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:8

144 Aortic Insufficiency (AI)

➣Wide pulse pressure

Waterhammer pulse (Corrigan’s pulse)

Carotid pulse (prominent sharp upstroke; occasionally bisfe-

riens)

Head bobbing (DeMusset’s sign)

Capillary pulsations in nail bed (Quincke’s sign)

tests

ECG

■Acute AI

➣Maybe normal

■Chronic AI

➣Left atrial abnormality

➣Left ventricular (LV) hypertrophy

Chest X-Ray

■Acute AI

➣Maybe normal

■Chronic AI

➣Cardiac enlargement

➣Aortic dilatation

➣Calcification of ascending aorta (suggests syphilis as etiology)

➣Aortic valve usually not calcified with AI

Echo/Doppler(Extremely Important Test)

■Severity of AI

■LV systolic function

■LV diastolic and systolic dimensions

■Aortic root size

■Premature closure of mitral valve (often seen in acute severe AI)

Cardiac Catheterization

■Hemodynamics

➣Width of arterial pressure

➣LV end-diastolic pressure

➣Premature closure of mitral valve (LV diastolic pressure higher

than pulmonary capillary wedge)

■Left ventriculography

➣LV systolic function (LVEF)

➣LV diastolic and systolic volume index

■Aortography

➣Severity of AI