A.I
Causes
1. Rh. fever
$
® aneurysm in ascending Aorta ® A.I.
3. valvotomy (post valvotomy)
4. collagen D
® (Aorta is rich in collagen fibers)
ankylosis spondylitis.
¯

marfan $ weak wall of the Aorta
rheumatoid D.
¯

Endocarditis dilatation
Dissection of the aorta
¯

A.I
Heamodynamics
Regurged blood to Lt. V.
¯

Lt. V. dilatation
¯

Forceful contraction

­­ systolic reflex periph. V.D.
pressure
¯
¯¯ diastolic


wide pulse pr.

C/P
Chest pain + palpitation
¯¯

due to
¯¯ diastolic pressure v. load
¯

¯coronary filling
Late
® sympt of heart failure.
Mild case may be a sympt except for palpitation.

Peripheral signs of A.I

3 H & neck 3 U.L. 3 L.L.
Corrigan’s sign
: Marked carotid pulsation.
De-Musset sign
: Nodding of the head
Systolic thrill over the carotid
: Artery may be present due to rapid flow of blood (carotid shuddering).
Water hammer pulse
: This may be absent in the following conditions:
¯¯
COP. d.t. A.S. or Lt. V.F.

­­
diastolic bl pr due to systemic hypertension.
Mild A.I.

B.P.:
® Systolic ­

®
Wide pulse pressure
Diastolic
¯

capillary pulsation
: (Quincke’s) may be detected in nails, lips, the lobule of the ear and uvula (Muller’s)
Pistol shot femoralis
: Femoral is a loud sound heard with each pulse beat over the femoral artery (traube’s sign).
Duroziez’s sign
: Systolic & diastolic murmurs are heard over the femoral artery if a slight pr. is applied to it.
Hill’s sign
: normally bl. Pr. In L.L. is higher than in U.L. by 20 mm. Hg in A.I the difference is > 40 mm. Hg.
Local exam
Lt. V. ++ (dilatation).
Hyperdynamic apex.
Murmur
A2
A1
® soft, high pitched decrecent character
Apex.

Murmur over the apex
A. I.
Functional M.I due to Lt. V. dilatation.
Austin flint murmur (M.S)
N.B.
Causes of absence of periph Signs


M.S.
A.S. why ?

Lt. V.F.
¯ COP. ®

Mild A.I.
®¯ syst. Bl. Pr ® narrow pulse pr.
P. signs if present = Lt. V is compensated.

Investigation
E.C.G., echo, x-ray ® Lt. V.++ with dilatational the ascending aorta.

Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)