EpistemisSign of Duroziez
Specialty: Cardiovascular.
Why it occurs
- Chronic severe aortic valve insufficiency
- Severe hyperdynamic circulatory states (severe anemia, large-caliber arteriovenous fistula)
- Extreme aortic stiffness with moderate regurgitation
Initial workup
Transthoracic echocardiogram and continuous Doppler to quantitatively evaluate the aortic valve, quantify the effective regurgitant orifice, diastolic reflux volume, measure left ventricular diameters (dilation criteria) and assess ejection function; Doppler ultrasound of the femoral artery to graphically record holodiastolic retrograde flow; 12-lead electrocardiogram; Chest x-ray.
red flags
Detection of a systolic murmur followed by an audible diastolic murmur over the femoral artery when applying gradual pressure with the stethoscope (the diastolic murmur is generated by the retrograde flow of blood towards the chest during diastole), associated with dyspnea at rest, severe orthopnea, repetitive stress syncope, typical nocturnal anginous chest pain, or signs of acute pulmonary edema. It reflects a massive retrograde holodiastolic systemic flow towards the left ventricle through the aorta, confirming severe decompensated aortic insufficiency with risk of irreversible myocardial claudication, requiring scheduled or urgent valve surgical bypass.
Standard management
- Ramipril — ACEI to reduce peripheral vascular resistance and reduce left ventricular diastolic overload; 5 to 10 mg once a day orally, subject to blood pressure stability
- Amlodipine — dihydropyridine calcium antagonist indicated for blood pressure control and reduction of afterload; 5 to 10 mg per day orally
- Furosemide — loop diuretic indicated if there are signs of pulmonary venocapillary congestion; 20 to 40 mg orally per day
- Thiamine (indicated of choice if the sign is due to hyperdynamic heart failure secondary to wet beriberi; 100 mg intravenously or orally per day).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Cardiovascular
- Listed causes
- 3
- Treatment options
- 4