Physical-exam-mitral-regurgitation

• Early diastolic decrescendo murmur at LSB (RSB if dilated Ao root); ↑ w/ sitting forward, expir, handgrip; severity of AR ∝ duration of murmur (except in acute and severe late); Austin Flint murmur: mid-to-late diastolic rumble at apex (AR jet interfering w/ mitral inflow)
• Wide pulse pressure due to ↑ stroke volume, hyper-dynamic pulse; pulse pressure narrows in late AR with ↓ LV fxn; bisferiens (twice-beating) arterial pulse
• PMI diffuse and laterally displaced; soft S1 (early closure of MV); ± S3 (≠ ↓ EF but rather just volume overload in AR)

Classic Eponymous Signs in Chronic AR

Corrigan’s pulse “water hammer” pulse (ie, rapid rise/fall or distention/collapse) Hill’s sign (popliteal SBP – brachial SBP) >60 mmHg Duroziez’s sign to-and-fro murmur heard over femoral artery w/ light compression Pistol shot sounds pistol shot sound heard over femoral artery Traube’s sound double sound heard over femoral artery when compressed distally de Musset’s sign head-bobbing with each heartbeat (low Se) Müller’s sign systolic pulsations of the uvula Quincke’s pulses subungual capillary pulsations (low Sp)