Eponyms Linked with Aortic Regurgitation

Abstract

Eponyms are terms and names of medical phenomena in which name of the inventor (most often, but also name of the bearer of a sign, eventually toponymic name) substitute for a descriptive term. Eponyms aid our memory and also remind us of cultural and professional continuity of our knowledge. Aortic regurgitation is associated with an unusually large number of eponyms. The explanation lies in ubiquitous manifestation of blood flow with typically increased difference between systolic and diastolic pressure. While few of them are notoriously known, many other eponyms have ceased from everyday clinician’s use [1–3]. Most exhaustive list of aortic regurgitation eponyms was put together by Ashrafian in 2005 who himself also added a most recent eponym [4]:

• 1. Al-Razi, Razes (865–923 n. l.). Pounding hyperdynamic pulse later formally described by Corrigan.

• 2. Ashrafian (2005). Pulsating pseudo-proptosis (exophthamia).

• 3. Austin Flint murmur (1862). A mid-diastolic to late diastolic or presystolic mitral murmur best heard at the apex that is low-pitched and rumbling in the presence of aortic regurgitation with no underlying mitral pathology.

• 4. Becker sign (1828–1890). Increased retinal arteriole and pupillary pulsation, originally described in the context of Graves-Basedow disease.

• 5. Blumgart and Ernstene murmur (1933). Duroziez-type murmur (see below) elicited by subjecting arm to various temperatures of water and applying a sub-diastolic pressure below the auscultation site, allowing differentiation between regurgitation and vasodilatation.

• 6. Bozzolo sign (1845–1920). Pulsatile nasal mucosa.

• 7. Cole-Cecil murmur (1936). Early diastolic murmur radiated to the apex and left axilla first described in the context of syphilitic aortitis.

• 8. Corrigan pulse/sign (1832). Initially described as a visible pulsation now tactile test in carotid or larger arteries where a jumpy pulse that fully expands appears to suddenly collapse and be completely empty between beats. Associated with a widened pulse pressure. Also called cannonball, collapsing, pistol-shot, pulsus celer et altus, trip-hammer or water-hammer pulse. See Intermezzo 2 (page).

• 9. Cuming sign (1822). Pounding pulse associated with a widened pulse pressure. Later characterised in more depth by Corrigan (see above).

• 10. de Musset sign (1877) Alfred Louis Charles de Musset (1810–1857) was a French dramatist, poet, and novelist who suffered from syphilitic aortitis. First documented by his brother Paul in his biography, it describes a pulsatile, rhythmic nodding of the head in synchrony with the regurgitant heartbeat. See Intermezzo 3 (page).

• 11. Dennison sign (1959). Pulsatile cervix.

• 12. Drummond sign (1852–1932). Pulsatile systolic expulsion of air from nostrils when mouth is closed.

• 13. Duroziez sign (1861). Double intermittent, systolic-diastolic (antegrade-retrograde) murmur produced by compression of femoral artery with a stethoscope by altering proximal and distal stethoscope bell pressure.

• 14. Gerhardt sign (1833–1902). Pulsatile spleen (usually in the presence of splenomegaly).

• 15. Hill sign (1909). An exaggerated increase of systolic arterial pressure in lower compared to upper limbs.

• 16. Landolfi sign (1878–1959). Pulsatile pupils.

• 17. Lincoln sign (2004). Aortic regurgitation has been diagnosed in hindsight on Abraham Lincoln, the 16th President of the United States (1861–1865), with the valvular insufficiency arising from underlying Marfan’s syndrome. A blurred foot on photograph is denoted to represent foot movements corresponding to pounding lower limb arterial pulsations. See Intermezzo 4 (page).

• 18. Mayne sign (1953). Drop of more than 15 mmHg in diastolic BP when arm is raised.

• 19. Morton and Mahon sign (2002). Facial flushing and blanching corresponding to head and neck arterial pulsations.

• 20. Müller sign (1831–1908). Pulsating uvula, associated with erythema and oedema of the velum palati and tonsils.

• 21. Palmar click (unknown). Pulsating palms.

• 22. Penny sign (1988). Flashing wheal-exaggerated pulsatility noted in an urticarial skin reaction in patients with aortic regurgitation.

• 23. Pulsus bisferiens (unknown). Double systolic arterial wave separated by a midsystolic dip.

• 24. Quincke sign (1868). Exaggerated visible pulsation of red capillary colouration seen in nail beds that may be easier to denote by blanching part of the nail bed by slight pressure.

• 25. Rosenbach sign (1878). Pulsatile liver.

• 26. Shelley sign (1964). Pulsatile cervix.

• 27. Sherman sign (2004). An unexpectedly prominent and quickly found dorsalis pedis pulse (1–2 s) in patients aged 75 or older.

• 28. Traube sign (1872). On auscultation of the femoral artery, the presence of a booming double sound or “pistol shot”.

• 29. Traube pulse (1872). A sub-category of Pulsus bigeminus. Alternate high and low character pulses, where the low pulses are closer to the end of the previous high pulse than to the next high pulse.

• 30. Vieussens pulse (1641–1715). Hyperdynamic pulse later formally described by Corrigan (see above).

• 31. Watson pulse (1920). Known as water hammer pulse, brisk femoral pulsation similar to that felt with a water hammer—a Victorian toy consisting of a glass tube filled partly with water or mercury in a vacuum. The water or mercury produced a smacking impact when the glass tube is inverted.