Locomotor Brachii Sign in Aortic Regurgitation
A 60-year-old man with a history of ischemic stroke presented to the cardiology clinic with a 3-month history of dyspnea on exertion. His blood pressure was 141/55 mm Hg, with an elevated pulse pressure of 86 mm Hg. On physical examination, there was a grade 2/6 systolic murmur and a grade 3/4 diastolic murmur in the right second intercostal space. The carotid pulses were bounding. Both brachial arteries were noted to be tortuous and visibly pulsatile, enlarging in systole and rapidly collapsing in diastole (see video) — a finding known as locomotor brachii sign. Locomotor brachii sign can be seen in patients with aortic regurgitation owing to the wide pulse pressure and diastolic reversal of flow associated with severe valvular insufficiency. The sign may also be seen in patients with severe arteriosclerosis. In this patient, a transthoracic echocardiogram showed a bicuspid aortic valve with severe regurgitation, a moderately enlarged left ventricle, a mildly dilated aortic root, and a normal ascending aorta. Spectral Doppler ultrasonography of the brachial arteries revealed diastolic flow reversal. A final diagnosis of chronic severe aortic regurgitation was made. The patient was referred for surgical aortic-valve replacement.