Landolfi's Sign: A Riddle for Primary Care Physicians

Area of Science:

• Cardiology
• Ophthalmology

Background:

• Landolfi's sign, characterized by alternating pupillary constriction and dilatation, is a clinical sign associated with aortic regurgitation.
• Aortic regurgitation is often linked to degenerative and rheumatic heart diseases, prevalent in rural India where patients may present late with complications.

Purpose of the Study:

• To report a case of severe aortic regurgitation presenting with Landolfi's sign in a pregnant female.
• To emphasize the significance of bedside clinical skills and diagnostic tools in primary healthcare settings.

Main Methods:

• Clinical examination to identify Landolfi's sign.
• Doppler echocardiography for diagnosis of severe aortic regurgitation.
• Management with anti-failure medications and close feto-maternal monitoring.

Main Results:

• A 34-year-old pregnant female presented with acute heart failure and Landolfi's sign.
• Doppler echocardiography confirmed severe aortic regurgitation.
• The patient was stabilized, and feto-maternal health was monitored.

Conclusions:

• Bedside clinical training in cardiology is crucial, particularly in primary healthcare facilities with limited resources.
• Basic diagnostic tools like echocardiography should be accessible in primary healthcare centers for timely diagnosis and management of critical conditions like aortic regurgitation.