Antibiotics in farm animals . . . and other storiesBMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5821 (Published 10 October 2019) Cite this as: BMJ 2019;367:l5821
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We read with interest the Minerva article about deMusset’s sign and its earlier recognition by William Withering. In severe acute aortic regurgitation, most commonly due to aortic valve endocarditis a form of extreme diastolic ventricular interaction may result in the appearance of a prominent diastolic jugular venous pulsation. At first sight it appears to be a giant V wave of tricuspid regurgitation but when timed it is found to occur in mid to late diastole. This distinct jugular venous pulse abnormality is caused by rapid left ventricular enlargement in early diastole which compresses the right ventricle thus arresting diastolic inflow. At the onset of systole the jugular venous pulse collapses as left ventricular contraction assists momentarily in right ventricular filling. A convincing video of this physical sign has been published (Ventricular Interaction in the Jugular Venous Pulse (2019) SA Almoosawy, Buchan K, Cross S. Asian Cardiovascular and Thoracic Annals, May 24th 2019. https://www.ncbi.nlm.nih.gov/pubmed/31126189
Clinicians generally do not recognise abnormal physical signs unless they know what they are looking for. We expect that by publishing this case it will soon come to be recognised as another useful physical sign in the assessment of the severity of aortic regurgitation.
Competing interests: No competing interests