Only the more advanced forms of valvular heart disease may be visually detected: 1. Tricuspid regurgitation: Tricuspid regurgitation may be suspected on observation if there are ear lobe pulsations, a prominent v wave in the jugular venous pulse, as well as hepatic pulsations.
Fig. 7. (Color Plate 7, following p. 270) Mitral facies: 35-yr-old Polish female P1 G6 Ab4 showing a malar flush. She had mitral stenosis and mitral regurgitation.
2. Mitral stenosis: Caucasian patients with mitral stenosis may have venous telangiectasia of the cheeks (malar flush) because of a low-output state and an elevated pulmonary vascular resistance (88) (Fig. 7).
3. Aortic regurgitation: A patient may be suspected of having aortic regurgitation if he presents with dyspnea, a head that shakes with each arterial pulsation (de Musset's sign), and prominent arterial pulsations in the neck.
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