A site for medical students - Practical,Theory,Osce Notes

Differentiate aortic regurgitation due to syphilis and rheumatic AR

How will you differentiate between aortic regurgitation due to syphilis and rheumatic fever?

The pathology of AR in syphilis and rheumatic fever are different. In syphilis there is aortic root dilatation and in rheumatic fever there is valve damage.
Features of Rheumatic AR
1.    Usually affect young individuals
2.    Past history of rheumatic fever may be present
3.    Other valves may be affected
4.    Usually there is no diastolic thrill
5.    A2 diminished 
6.    Murmur is of blowing character
7.    It is best heard on 3rd left intercostals space
8.    Peripheral signs of AR are present.
Features of syphilitic AR
1.    Older individuals are affected
2.    History of exposure to syphilis present
3.    Syphilitic AR is usually an isolated lesion
4.    Diastolic thrill is more common than rheumatic AR
5.    A is usually loud tambour like
6.    Murmur is ringing, cooing, or musical in nature
7.    Best heard along the right sternal border.
8.    Peripheral sign are more marked than rheumatic AR.