Abstract
A multitude of cardiac and peripheral phenomena, eponymously ascribed as signs, have been described in aortic regurgitation (AR) to honor physicians’ contributions to medicine. They were identified based on applying the bedside skills of observation, auscultation, palpation, maneuvers, and the sphygmomanometer. These bedside signs have diminished in use since the advent of echocardiographic and other imaging techniques of the heart. With the exception of Corrigan, Duroziez, and Hill signs, they have not been well studied and gaps remain in knowledge regarding evidence of their applicability in clinical practice. In general, for those signs which have been studied, there are a number of limitations with studies such as selection bias, inconsistent case definition and reference standard, and wide ranges of disease severities. Additionally, there is a paucity of data assessing the relationship between a sign and disease severity. Despite these shortcomings, we contend that these signs should be taught since they impart an appreciation for the keen insights applied by physicians in recognizing or eliciting them on physical examination. They also further enhance our understanding about the pathophysiology of disease and provide opportunities for further investigation. Described in this chapter is brief historical information of the person who reported the sign, its original description, and if known, its sensitivity, specificity, and validity in clinical practice. The name for the description of this pathological finding affecting the aortic valve has changed over the years and has encompassed such terms as retroversion of the valves, incompetence, insufficiency, and regurgitation. It is understood that each term is meant to describe the condition by which the aortic valves do not close tightly causing blood to flow back into the left ventricle during diastole.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Dalton C. Chapter 4: Galen. In: Doctrines of the Circulation: A History of Physiological Opinion and Discovery in Regard to the Circulation of the Blood. Philadelphia: Henry C. Leas’s Son & Co; 1884. p. 250–1.
Galen. Synopsis of chapters. In: Galen on the Natural Facilities. Brock AJ, translator. London: William Heinemann; 1916. p. xliii–1.
Vieussens R. De la structure de la surface interne de ventricule gauche du coeur. In: Traité nouveau de la structure et des causes du mouvement naturel du coeur. Toulouse: Jean Guillemette; 1715. p. 101–20.
Cowper W. Of ossifications or petrifications in the coats of arteries, particularly in the valves of the great artery. Phil Trans. 1702–1705;23–24:1970–7.
Bertin RJH. Introduction. In: Traité des maladies du coeur et des gros vaisseaux. Paris: J.-B. Baillière; 1824. p. xvii–xlviii.
Hodgkin T. On retroversion of the valves of the aorta. Lond M Gaz. 1828–1829;3:433–43.
Willius FA, Keys TE. Austin Flint (1812–1886). In: Classics of Cardiology, vol 2. New York: Dover Publications; 1941. p. 499–501.
Flint A. On the distinctive characters of the pulmonary signs obtained by percussion and auscultation. Am J M Sc. 1862;43–4:305–20.
Flint A. On cardiac murmurs. Am J M Sc. 1862;43-4:29–54.
[No author]. Obituary: Thomas Cuming. Br Med J. 1887;2:653.
Cuming T. A case of diseased heart with observations. Dublin Hosp Rep. 1822;3:319–34.
Zacek P. Eponyms linked with aortic regurgitation. In: Vojacek J, Zacek P, Domiik J, editors. Aortic Regurgitation. Cham: Springer International Publishing; 2016. p. 41–2.
Kligfield P. An annotation of the pulse in aortic regurgitation: Thomas Cuming, 1822. Am J Card. 1979;44:370–1.
Willius FA, Keys TE. Sir Dominic John Corrigan (1802–1880). In: Classics of Cardiology, vol. 2. New York: Dover Publications; 1941. p. 419–22.
O’Brien ET. The man behind the eponym: Sir Dominic John Corrigan (1802–1880). N Engl J Med. 1981;304:365–6.
[No author]. Obituary: Sir Dominic J Corrigan, Bart M.D. Edin. Lancet. 1880;118:268–9.
[No author]. Obituary: Sir Dominic John Corrigan, Bart M.D. Br Med J. 1880;1:227.
Major RH. Dominic John Corrigan (1802–1880). In: Classic Descriptions of Disease with Biographical Sketches of the Authors. 3rd ed. Illinois: Charles C. Thomas; 1932. p. 352–6.
Corrigan D. Address delivered on the occasion of the distribution of prizes in St. Mary’s hospital medical school. Lancet. 1873;2:409–13.
Agnew RA. The achievement of Dominic John Corrigan. Med Hist. 1965;9:230–40.
Stone J. Sir Dominic John Corrigan. In: Profiles in Cardiology. New Jersey: The Foundation for Advances in Medicine and Science; 2003. p. 64–7.
Corrigan DJ. On permanent patency of the mouth of the aorta, or inadequacy of the aortic valves. Edinb Med Surg J. 1832;37:225–45.
Hope J. Signs, diagnosis, prognosis, and terminations of disease of the valves: pulses in regurgitation through the aortic valves. In: A Treatise of the Diseases of the Heart and Great Vessels and on the Affections which may be Mistaken for Them. Philadelphia: Lea and Blanchard; 1846. p. 362.
Babu AN, Kymes SM, Carpenter-Fryer SM. Eponyms and the diagnosis of aortic regurgitation: what says the evidence? Ann Intern Med. 2004;138:736–42.
[No author]. Sir Thomas Watson. Br Med J. 1882;2:1282.
[No author]. Obituary: Sir Thomas Watson. Lancet. 1882;2:1131.
[No author]. Obituary: Sir Thomas Watson, MD FRS. Med Rec. 1822;22:723.
Munk W. Thomas (Sir) Watson Lives of the fellows. Heritage Centre: Royal College of Physicians. London; 2009. http://munksroll.rcplondon.ac.uk/Biography/Details/4657. Accessed 9 Mar 2019.
[No author]. Obituary: Sir Thomas Watson. Med Times Gaz. 1882;2:735–7.
Watson T. Disease of the heart. In: Lectures on the Principles and Practice of Physic. Philadelphia: Lea and Blanchard; 1844. p. 585–607.
Suvarna JCD. Watson’s hammer pulse. J Postgrad Med. 2008;54:163–5.
Mackenzie J. Valvular defects. In: Diseases of the Heart. London: Oxford Medical Publications; 1918. p. 329–35.
Major RH. Paul-Louis Duroziez: diseases of the circulatory system. In: Classic Description of Disease. Illinois: Charles C. Thomas; 1945. p. 363–4.
Berry D. History of cardiology: Paul Louis Duroziez, MD. Circulation. 2006;114(22):188.
Wilius FE, Keys TE. Paul Louis Duroziez (1826–1897). In: Classic of Cardiology, vol. 2. New York: Dover Publications; 1941. p. 492–6.
Duroziez P. Du double souffle intermittent crural, comme signe de l’insuffisance aortique. Arch Gén de Méd. 1861;17:417–43.
Virchow R. Zur Erinnerung an L. Traube. Berl klin Wchnschr. 1876;13:209–10.
Morrison H. Ludwig Traube. Boston Med Surg J. 1927;196:1097–101.
Singer I. Traube, Ludwig. In: The Jewish Encyclopedia, vol. 12. New York: Funk and Wagnalls Company; 1907. p. 235.
Brog HW. Flashback on evidence-based medicine: the Prussian Geheim Rath. JPANDS. 2015;20:92–4.
Fraentzel [O]. Ueber zwei eigentümliche Phänomene bei Insuffizienz der Aortenklappen. Berl klin Wchnschr. 1867;4:355–457.
Traube L. Ueber den Doppelton in der Cruralis bei Insuffizienz der Aortenklappen. Berl klin Wchnshr. 1872;9:573–4.
Sapira JD. The heart. In: The Art & Science of Bedside Diagnosis. Baltimore: Williams & Wilken; 2012. p. 283–330.
Minagar A, Lowis GW. Dr Heinrich Irenaeus Quincke (1842–1922): clinical neurologist of Kiel. J Med Biogr. 2001;9:12–5.
[No author]. Obituary: Heinrich Irenaeus Quincke. J Nerv Ment Dis. 1922;56:547–8.
Cozanitis DA. Heinrich Irenaeus Quincke (1842–1922): the Nobel Prize but for the problem of age. Presse Med. 2013;42:464–79.
[No author]. Obituary: Heinrich Quincke. Lancet. 1922;202:1259.
[No author]. Clinical of Kiel: Heinrich Irenaeus Quincke (1842–1922). JAMA. 1966;196:1152–3.
Heinrich Quincke. The University of Glasgow Story. University of Glasgow. https://www.universitystory.gla.ac.uk/biography/?id=WH27240&type=P. Accessed 2 May 2019.
Pearce JMS. Walter Essex Wynter, Quincke, and lumbar puncture. J Neurol Neurosurg Psychiatry. 1994;57:179.
Quincke H. Beobachtungen über capillar- und venenpuls. Berl klin Wchnschr. 1868;5:357–9.
Czerny V. Otto Becker gedächtnisrede gehalten im Auftrage der medizinischen Fakultät in der Aula der Universität. Heidelberg: Gustav Koester; 1890. p. 3–12.
Becker O. Ueber die sichtbaren Erscheinungen der Blutbewegung in der menschlichen Netzhaut. Arch f Opth. 1872;18:206–96.
De Musset A. May night. In: The Poet and the Muse. London: Richard Bentley and Son; 1880. p. 10–17.
De Musset P. The Biography of Alfred de Musset. Preston HW, translator. Boston: Roberts Brothers; 1877.
Singer I. Haneman FT. Ottomar Ernst Felix. Jewish Encyclopedia. Rosenbach; 1906. http://www.jewishencyclopedia.com/articles/12837-rosenbach-ottomar-ernst-felix. Accessed 10 Mar 2019.
Guttman W. Zum andenken an Ottomar Rosenbach. Leipzig: Verlag von J.A. Barth; 1908. p. 5–16.
Faber K. Nosography in modern internal medicine. Ann Med Hist. 1922;4:1–63.
Morrison H. Ottomar Rosenbach, pioneer in the development of the concept of functional disease and functional diagnosis in internal medicine. Ann Intern Med. 1937;11:527–36.
[No author]. Ottomar Rosenbach. Med Brief. 1907;35:367.
Rosenbach O. Ueber arterielle Leberpulsation. Deutsche med Wchnschr. 1878;6:498–500, 519–23.
Heubner O. Carl Gerhardt. Jahrb f Kinderh. 1902;56:250–2.
Jacobi A. In memoriam Carl Gerhardt, birth May 5, 1833, died July 21, 1902. In: Robinson WJ, editor. Miscellaneous Addresses and Writings, vol. 7. New York: The Critic and Guide Company; 1909. p. 499–500.
Gerhardt C. Metallklang. In: Lehrbuch der Auscultation und Percussion: mit besonderer Berücksichtigung der Besichtigung, Betastung und Messung der Brust und des Unterleibes zu diagnostischen Zwecken. Tübingen: Verlag der H. Laupp’schen Buchhandlung; 1833. p. 184–7.
Hall CW. Gerhardt, Karl Jakob Christian Adolph. In: A Biographical Dictionary of People in Engineering: From the Earliest Records to 2000. Indiana: Purdue University Press; 2008. p. 81.
Medvei VC. The story of insulin. In: The History of Clinical Endocrinology. Carnforth, Lancs: The Parthenon Publishing Group; 1993. p. 249–57.
White FA. Gerhardt’s sign. In: Physical Signs in Medicine and Surgery: Rare, Lost and Forgotten Physical Signs. Ocala: Museum Press Books; 2009. p. 106.
Gerhardt C. Pulsierender milztumor. Ztschr f klin Med. 1882;4:449–50.
Gerhardt C. Aorteninsuffizienz und milz pulsationen. Centralbl f klin Med. 1888;9:1–4.
Wormer EJ. Müller, Friedrich von. Neue deutsche Biographie. 1997;18:379–81.
[No author]. Friedrich von Muller. Br Med J. 1951;2:340.
Biografie, Friedrich von Muller. Wissenschaftliche sammlungen. Teil-Katalog der wissenschaftlichen sammlungen. Humbolot-Universitat zu Berlin. https://www.sammlungen.hu-berlin.de/objekte/-/17224/. Accessed 15 May 2019.
[No author]. Friedrich von Müller and William Osler. N Engl J Med. 1955;252(2):76–7.
Mueller F. Pulsation des Gaumens bei Aorteninsuffizienz. In: Zur Pathologie des weichen Gaumens. Berlin: Charité-Annalen; 1889. p. 251–2.
Douglas CG. Leonard Erskine Hill, 1866–1952. Biographical memoirs of fellows of the Royal Society: The Royal Society Publishing; 1953. https://royalsocietypublishing.org/doi/abs/10.1098/rsbm.1953.0009. Accessed 10 May 2019.
Hill AB, Hill B. The life of Sir Leonard Erskine Hill FRS (1866–1952). Proc Roy Soc Med. 1968;61(3):307–16.
[No author]. Group Captain Martin Flack, C.B.E. Br Med J. 1931;2(3686):402–4.
[No author]. Major (Hon. Lt.-Col) Martin William Flack, M.B., Central Chancery of the Orders of Knighthood, Royal Air Force. Lond M Gaz. 1918;31098:92.
Dr. Wilfred Watkinson Holtzmann BS MB FRCS. The West Dorset Hanns. 2019. https://www.hannfamily.org.uk/Hannfamily-o/p79.htm. Accessed 2 Jun 2019.
Watkinson, Wilfred (1877–1944). Royal College of Surgeons. Plarr’s Lives of the Fellows. The Royal College of Surgeons of England. 2013. https://livesonline.rcseng.ac.uk/client/en_GB/lives/search/detailnonmodal/ent:$002f$002fSD_ASSET$002f0$002f376931/one?qu=%22rcs%3A+E004748%22&rt=false%7C%7C%7CIDENTIFIER%7C%7C%7Cresource+Identifier. Accessed 6 May 2019.
Hill L, Flack M, Holtzman W. The measurement of systolic blood pressure in man. Heart. 1909;1:73–82.
Hill L, Rowlands RA. Systolic blood pressure: (1) in change of posture, (2) in cases of aortic regurgitation. Heart. 1911-1912;3:219–22.
Frank MJ, Casanegra P, Migliori AJ, Levinson GE. The clinical evaluation of aortic regurgitation. Arch Intern Med. 1965;116:219–23.
Landolfi M. Un nouveau signe de l’insuffisance aortique: l’hippus circulatoire. Semaine méd. 1909;29:349.
Minervini L. L’universita italiana. Rivista dell’istruzione superiore. 1924;20:152.
Minervini L. Le pouls de la langue dans l’insuffisance aortique. Semaine méd. 1910;30:481–90.
[No author]. Joseph Sailer RD. Am J Surg. 1929;7:576–8.
Sailer J. Pulsating spleen in aortic insufficiency. Am Heart J. 1928;3:447–53.
[No author]. Francis Winslow Palfrey, 1876–1953. N Engl J Med. 1953;9:383–4.
[No author]. Corporation records. The Harvard Graduates’ Magazine. 1917;26:103–300.
Francis Winslow Palfrey, Clinical Medicine. [Internet]. Assistants. Quinquennial Catalogue of the Officers and Graduates of Harvard University. 1636–1910. Cambridge Massachusetts. Published by the University 1910. https://books.google.com/books?id=J3MqAAAAYAAJ&pg=PA105&lpg=PA105&dq=Francis+Winslow+Palfrey&source=bl&ots=omHzd6Voki&sig=FlvffU8Fg-qiV3Vi1AtF8lghmBE&hl=en&sa=X&ved=2ahUKEwiD4oGAxb7fAhUBba0KHUyHDcwQ6AewD3oECAMQAQ#v=onepage&q=Francis%20Winslow%20Palfrey&f=false. Accessed 20 Mar 2019.
Palfrey FW. Auscultation of the Corrigan or water-hammer pulse. N Engl J Med. 1952;247:771–2.
Irish Cardiac Society. Annual Scientific Meeting & AGM. 6–8 October 2016 Newpark Hotel, Kilkenny, Ireland. http://www.irishcardiacsociety.com/documents/ICS_AGM_Prog_2016_SCREEN.pd. Accessed 10 May 2019.
Meath Hospital, Dublin: annual report for the year ended 31st December 1979. Lenus The Irish Health Repository. https://www.lenus.ie/bitstream/handle/10147/45526/8189.pdf?sequence=1&isAllowed=y. Accessed 5 May 2019.
Mayne B. On aortic regurgitation: a new physical sign. Ir J Med Sci. 1953;6:80–1.
Happes M, Kamran H, Salciccioli L, Ko EH, Lazar JM. Mayne’s sign is mainly related to younger age and not to aortic regurgitation. Blood Press Monit. 2010;15:305–7.
Abbas F, Sapira JD. Mayne’s sign is not pathognomonic of aortic insufficiency. South Med J. 1987;80:1051–2.
Dennison AD Jr. Aortic regurgitation multiple eponyms, physical signs and etiologies. J Indiana State Med Assoc. 1958;52:1283–9.
Leonard JJ. Profiles in cardiology: W. Proctor Harvey. Clin Cardiol. 1991;14:180–2.
Biography of W. Proctor Harvey. Georgetown University School of Medicine. https://som.georgetown.edu/harveysociety/harveyfounderbio. Accessed 12 Apr 2019.
Robertson E. Watkins Proctor Harvey, cardiologist, dies at 89. Richmond Times Dispatch. 7 Oct 2007.
W. Proctor Harvey Amphitheater. Notes from Neil. Sunday, October 25, 2015. http://medstarresearch.blogspot.com/2015/10/w-proctor-harvey-amphitheater.html. Accessed 10 May 2019.
Harvey WP, Corrado MA, Perloff JK. Right-sided murmurs of aortic insufficiency (diastolic murmurs better heard to the right of the sternum rather than the left). Am J Med Sci. 1963;245:29–43.
Dr. William Penny. British Cardiovascular Society. http://www.bcs.com/programmesessions/biog.asp?bcsid=805. Accessed 14 May 2019.
Dr. William J Penny, Consultant Cardiologist MD, FRCP. Spire Cardiff Hospital. https://www.spirehealthcare.com/spire-cardiff-hospital/consultants/dr-w-j-penny-c1390182/. Accessed 10 Jan 2019.
William J Penny (Cardiff, UK) editorial board Postgrad Med J. The journal of continuing professional development. 2006. https://pmj.bmj.com/content/postgradmedj/82/964.toc.pdf. Accessed 12 May 2019.
Penny WJ. The sign of the flashing wheal in aortic regurgitation. Am J Cardiol. 1988;6:1158–9.
Morton G, Mahon S. The facial flushing or aortic regurgitation. Anaesthesia. 2002;57:501–2.
Dr. Simon Mahon. Linkedin. https://www.linkedin.com/in/dr-simon-mahon-22816a43/?originalSubdomain=uk. Accessed 4 Mar 2020.
Fredrick T Sherman. Mount Sinai. Ichan School of Medicine at Mount Sinai. https://www.mountsinai.org/profiles/fredrick-t-sherman. Accessed 10 May 2019.
Fredrick T. Sherman MD, MSc. Linkedin. https://www.linkedin.com/in/fredrick-t-sherman-md-msc-a25a1823. Accessed 10 May 2019.
Sherman FT. Sherman sign predicts aortic regurgitation: from foot fetish to clinical pearl. Geriatrics. 2004;59:7.
Hutain Ashrafian. Likedin. https://www.likedin.com/in/hutan-ashrafian-2a8993169/. Accessed 10 May 2019.
Ashrafian H. Pulsatile pseudo-proptosis, aortic regurgitation and 31 eponyms. Int J Cardiol. 2008;107:421–3.
Henkind P, Priest RS, Schiller G. Prolapse of iris, surgical proptosis. In: Compendium of Ophthalmology. Philadelphia: J.B. Lippincott Company; 1983. p. 242.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Yale, S.H., Tekiner, H., Mazza, J.J., Yale, E.S., Yale, R.C. (2021). Aortic Regurgitation Murmurs. In: Cardiovascular Eponymic Signs. Springer, Cham. https://doi.org/10.1007/978-3-030-67596-7_5
Download citation
DOI: https://doi.org/10.1007/978-3-030-67596-7_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-67595-0
Online ISBN: 978-3-030-67596-7
eBook Packages: MedicineMedicine (R0)