Landolfi’s Sign : Definition, Causes, Pathophysiology, & Presentation
- Change in pupillary size i.e. alternating dilatation & constriction of pupil in accordance with cardiac cycle and not related to light.
- It is seen in aortic regurgitation.
Aortic Regurgitation (Aortic Insufficiency)
Definition
- Aortic regurgitation (AR) is the regurgitation of blood through aortic valve of the heart in reverse direction during ventricular diastole.
- It can be acute or chronic.
Types
- Valve disease
- Root disease
| Feature | Valve disease | Root disease |
| Occurence | Most common (80%) | Less common (20%) |
| Pathology | Aortic valve involvement | Aortic wall involvement |
| Causes | Rheumatic heart disease Infective endocarditis Bicuspid aortic valve Congenital fenestration of AV AV prolapse associated with VSD 2° AR in membranous sub-aortic stenosis |
Syphilis Rheumatoid arthritis Ankylosing spondylitis Marfan’s syndrome Ehlers-Danlos syndrome Takayasu’s arteritis Aortic dissection Systemic hypertension Osteogenesis imperfecta Idiopathic dilatation of aorta Annuloaortic ectasia |
Clinical Features
Symptoms
Asymptomatic (for years or decades)
⇓
Once decompensated, deteriorates rapidly
⇓Symptomatic
Dyspnoea
Palpitation
Angina (Nocturnal angina)
PND
Syncope
Peripheral sign of wide pulse pressure
- Corrigan’s sign
- Water hammer pulse (Corrigan’s pulse, collapsing pulse)
- De Musset’s sign: To & fro motion of the head synchronous with the cardiac pulse.
- Quincke’s sign: Increased capillary pulsations felt by applying gentle pressure on the nails or gently grasping the fingers.
- Traube’s sign: Pistol shot sound over femoral arteries.
- Duroziez’s murmur: Diastolic murmur heard over the femoral artery when the diaphragm of the stethoscope is pressed distally.
- Hill’s sign: There is increase in femoral artery pressure over the brachial artery pressure by more than the normal difference of 10 mm of Hg. The larger the difference, the more severe is the aortic incompetence.
Investigations
- ECG
- Chest X-Ray
- Echocardiography
- Doppler echo
- Cardiac catherterisation
- Coronary angiography
- Tests to rule out syphilitic aetiology & connective tissue disorders
Treatment
A. Medical
1. Hypertension control
2. Treat underlying cause
3. RHD prophylaxis
4. Medical management of heart failure
B. Surgical
Indications
- Severe symptomatic aortic regurgitation (AR)
- Severe asymptomatic AR if LVEF <50%
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