Collapsing pulse

Collapsing pulse
Other namesCorrigan's pulse
Differential diagnosisaortic regurgitation

Watson's water hammer pulse, also known as Corrigan's pulse or collapsing pulse, is the medical sign (seen in aortic regurgitation) which describes a pulse that is bounding and forceful,[1] rapidly increasing and subsequently collapsing,[2] as if it were the sound of a water hammer that was causing the pulse. A water hammer was a Victorian toy in which a tube was half filled with fluid, the remainder being a vacuum. Each time the tube was inverted or shaken, the impact of the fluid at each end would sound like a hammer blow.[3][4]

This is associated with increased stroke volume of the left ventricle and decrease in the peripheral resistance leading to the widened pulse pressure of aortic regurgitation.

Diagnosis

To feel a water hammer pulse: with the patient reclining, the examiner raises the patient's arm vertically upwards. The examiner grasps the muscular part of the patient's forearm. A water hammer pulse is felt as a tapping impulse that is transmitted through the bulk of the muscles. This happens because the blood that is pumped to the arm during systole is emptied very quickly due to the gravity effect on the raised arm. This results in the artery emptying back into the heart during diastole, increasing preload, and therefore increasing cardiac output, (as per the Frank–Starling mechanism) so that systolic blood pressure increases and a stronger pulse pressure can be palpated. [5]

Causes

Water hammer pulse is commonly found when a patient has aortic regurgitation. It can also be seen in other conditions which are associated with a hyperdynamic circulation. A more comprehensive list of causes follows:[6]

Eponym

"Watson's water hammer pulse" and "Corrigan's pulse" refer to similar observations. However, the former usually refers to measurement of a pulse on a limb, while the latter refers to measurement of the pulse of the carotid artery.[1]

  • "Corrigan's pulse" is named for Sir Dominic Corrigan, the Irish physician, who characterized it in 1832.[7][8]
  • "Watson's water hammer pulse" is named for Thomas Watson, who characterized it in 1844.[1]

See also

References

  1. 1 2 3 Suvarna JC (2008). "Watson's water hammer pulse". J Postgrad Med. 54 (2): 163–5. doi:10.4103/0022-3859.40791. PMID 18480541.
  2. ↑ Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 978-0-7817-7153-5.
  3. ↑ von Kries, J. (1883), "Ueber die Beziehungen zwischen Druck und Geschwindigkeit, welche bei der Wellenbewegung in elastischen Schläuchen bestehen" [On the relationships between pressure and velocity, which exist in connection with wave motion in elastic tubing], Festschrift der 56. Versammlung Deutscher Naturforscher und Ärzte (Festschrift of the 56th Convention of German Scientists and Physicians) (in German), Tübingen, Germany: Akademische Verlagsbuchhandlung: 67–88, archived from the original on 2017-03-28
  4. ↑ von Kries, J. (1892), Studien zur Pulslehre [Studies in Pulse Science] (in German), Tübingen, Germany: Akademische Verlagsbuchhandlung, archived from the original on 2017-03-28
  5. ↑ "Aortic Regurgitation". The Lecturio Medical Concept Library. Retrieved 29 June 2021.
  6. ↑ Pabba, K; Safadi, A; Boudi, B (2021). "Water Hammer Pulse". National Center for Biotechnology Information, U.S. National Library of Medicine. PMID 30252374. Retrieved 29 June 2021.
  7. ↑ synd/3006 at Who Named It?
  8. ↑ D. J. Corrigan. On permanent patency of the mouth of the aorta, or inadequacy of the aortic valves. The Edinburgh Medical and Surgical Journal, 1832, 37: 225-245.
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