Eponyms and the Diagnosis of Aortic Regurgitation

TO THE EDITOR:

As a “bedside” educator and clinician who frequently refers to eponyms, especially those associated with aortic regurgitation, I very much appreciated the review article by Babu and colleagues (1) on aortic regurgitation and the discrepancy between textbooks and the literature. It has caused me to reassess the value of eponyms on teaching rounds. I would, however, note an error with regard to pulse pressure in Babu and colleagues' summary statement on the pathophysiologic characteristics of the Corrigan pulse, which was attributed to their reference 35 (2). Their statement read, “A recent investigation found that patients with aortic regurgitation had increased amplitude of the pulse, lower mean arterial pressure, and narrower pulse pressure than normal patients.” The last part of the statement, “narrower pulse pressure than normal patients,” disturbed me because chronic aortic regurgitation almost invariably leads to higher systolic pressure, lower diastolic pressure, and resultant wider pulse pressure. I read the original article by Warnes and colleagues and found that their original experimental observation was as follows: “the pulse pressure was also reduced with elevation (of the wrist). In normal subjects, pulse pressure decreased from an average of 70 mm Hg in the resting position to 61 mm Hg in the vertical position. In those with aortic regurgitation, it decreased from an average of 140 to 125 mm Hg” (2). Therefore, one must conclude that Warnes and colleagues' study did not show a narrower pulse pressure in patients with aortic regurgitation, but rather confirmed such. It did show that the pulse pressure narrowed with elevation of the wrist but was still significantly wider than that of normal patients, that is, an average of 70 mm Hg in normal patients versus 140 mm Hg in patients with aortic regurgitation.