Lancisi’s Sign
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A 60-year-old man with nonischemic cardiomyopathy presented with progressive dyspnea and weight gain of approximately 9 kg that had developed over a period of 2 to 3 weeks. On examination, a grade 2/6 holosystolic murmur that augmented with inspiration was noted at the left lower sternal border. Examination of the neck revealed a palpable, monomorphic venous pulsation, known as Lancisi’s sign. Transthoracic echocardiography revealed malcoaptation of the tricuspid-valve leaflets as a result of annular dilatation, with resultant severe regurgitation. Lancisi’s sign is a physical finding of severe tricuspid regurgitation. Normally, three peaks and two troughs characterize the venous waveform (the lower strip is a generic representation of normal findings, for comparison). The first peak, called the a wave, results from atrial contraction during late diastole...

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