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Editor’s notes: Ever wondered about the numerous clinical signs of aortic regurgitations, which the examiners and your colleges are so fond of. Never seen them in "standard " clinical textbooks and their mechanisms poorly described by its ardent followers, even though widely revered. Are they clinically and scientifically correct. The following article in Annals of Internal medicine may help you. If interested in reading the full article you may contact the editor’s email..................

Eponyms and the Diagnosis of Aortic Regurgitation:
What Says the Evidence?

Ajit N. Babu, MBBS, MPH; Steven M. Kymes, PhD, MHA; and Sharon M. Carpenter Fryer, MS, RD


Background: Chronic aortic regurgitation can lead to significant
morbidity and mortality. For more than a century, numerous eponymous
signs of aortic regurgitation have been described in textbooks
and the literature.

Purpose: To compare current textbook content with the peerreviewed
literature on the eponymous signs of aortic regurgitation
and to assess the role of these signs in clinical practice.
Data Sources: 11 textbooks, MEDLINE (1966 through October
2002), and bibliographies of textbooks and relevant papers.
Study Selection: English-language reports that were related to
the properties of a sign on physical examination, incorporated
more than 10 adults, and did not involve prosthetic heart valves or
acute aortic regurgitation.

Data Extraction: Three investigators independently analyzed
relevant textbook extracts and 27 reports, using predetermined
qualitative review criteria. Data relating to diagnostic accuracy and
properties of the index test were also extracted.

Data Synthesis: Twelve eponymous signs were described as
having varying degrees of importance by textbook authors. Only
the Austin Flint murmur, the Corrigan pulse, the Duroziez sign,
and the Hill sign had sufficient original literature for detailed
review. Most reports were low quality, with varying sensitivities
for all signs. Except for the Hill sign, specificity tended to be poor.
Evidence for the Hill sign also suggested a correlation between the
popliteal–brachial gradient and aortic regurgitation severity.
Conclusions: Prominent textbook support of the eponymous
signs of aortic regurgitation is not matched by the literature.
Clinicians and educators should update and improve the evidence
for these signs to ensure their relevance in current medical practice.

Ann Intern Med. 2003;138:736-742. www.annals.org