2 Arterial Pulse
Four peripheral signs of aortic insufficiency are considered in terms of their original descriptions, their popularity, and their potential future clinical contribution. It is concluded that: (1) Quincke's capillary pulse sign is not useful. (2) de Musset's head bobbing sign is of undetermined but apparently low sensitivity and specificity. (3) Duroziez's femoral double intermittent murmur sign, as modified by Blumgart and Ernstene, is almost 100% specific for the diagnosis of aortic insufficiency. Since its sensitivity, when properly performed, is about 90%, especially in pure aortic insufficiency, it is highly recommended. (4) Hill's sign (a popliteal indirect systolic blood pressure which is 20 mm Hg greater than a simultaneously measured brachial indirect systolic blood pressure) though almost unknown, is useful in diagnosing all but the mild cases of aortic insufficiency, and is the only sign that may predict the degree of aortic insufficiency subsequently found angiographically.