Landolfi’s Sign: A Riddle for Primary Care Physicians

Landolfi’s sign, alternating systolic constriction and diastolic dilatation of pupils, is a clinical hallmark of aortic regurgitation. It is thought to stem from exacerbation of physiological circulatory hippus in the vessels of iris due to a wide pulse pressure in a backdrop of severe aortic valvular incompetence. Degenerative and rheumatic heart diseases are exquisitely common in rural India and often these patients turn up late with complications to the primary care physicians. Herein, the authors report a 34-year-old pregnant female who presented with acute heart failure, and on examination, Landolfi’s sign was found. It was immediately followed by Doppler echocardiography to stamp it as a case of severe aortic regurgitation. The patient was stabilized with anti-failure medications and feto-maternal health was closely monitored. The authors want to conclude claiming that bedside clinical training in cardiology will forever remain important, more so, while dealing patients at non-sophisticated primary health-care facilities. Besides, they also argue that basic tool supports like an echocardiography should be made available at those centers.