Watson's water hammer pulse
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Ogheneochuko Ajari, MB.BS, MS [3]
Synonyms and keywords: Corrigan's pulse, collapsing pulse, cannonball pulse, hyperkinetic pulse
Overview
Watson's water hammer pulse is the medical sign which describes a pulse that is bounding and forceful, as if it were the hitting of a water hammer that was causing the pulse. 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. Also, the carotid pulsations seen in aortic regurgitation is known as Corrigan's pulse.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. There are no known life threatening causes of Watson's water hammer pulse that would result in death or permanent disability if not treated within 24 hours.
Common Causes
Causes by Organ System
| Cardiovascular | Aortic regurgitation, aortopulmonary window, arteriovenous fistula, beriberi, bradycardia, complete heart block, cor pulmonale, leaking aortic valve prosthesis, mitral regurgitation, Paget's disease, patent ductus arteriosus, rupture of sinus of valsalva, systolic hypertension, truncus arteriosus, ventricular septal defect |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | No underlying causes |
| Ear Nose Throat | No underlying causes |
| Endocrine | Hyperthyroidism, thyrotoxicosis |
| Environmental | Heat |
| Gastroenterologic | Beriberi, cirrhosis of liver |
| Genetic | No underlying causes |
| Hematologic | Anemia |
| Iatrogenic | No underlying causes |
| Infectious Disease | Fever |
| Musculoskeletal / Ortho | Paget's disease |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | Beriberi, chronic alcoholism |
| Obstetric/Gynecologic | Pregnancy |
| Oncologic | No underlying causes |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | No underlying causes |
| Psychiatric | Anxiety, emotion |
| Pulmonary | Cor pulmonale |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Dental | No underlying causes |
| Miscellaneous | Chronic alcoholism, exercise, fever, heat |
Causes in Alphabetical Order
Physical Examination
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 waterhammer pulse is felt as a tapping impulse which 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, therefore causing a palpable pulse.
This is commonly found when a patient has a leaking prosthetic aortic valve.
Videos
Video demonstrating Corrigan's sign (rapid upstroke and collapse of the carotid artery pulse) {{#ev:youtube|C6mTmpP9Lvw}}
Related Chapters
References
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