View source for Watson's water hammer pulse

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{{SI}}
{{CMG}}; {{AOEIC}} {{CZ}} {{Ochuko}}

{{SK}} Corrigan's pulse, collapsing pulse, cannonball pulse, hyperkinetic pulse

==Overview==
Watson's water hammer pulse is the medical [[Sign (medicine)|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.

===Common Causes===
*[[Aortic regurgitation]]

===Causes by Organ System===

{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[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]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|- 
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"|[[Hyperthyroidism]], [[thyrotoxicosis]]
|- 
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[Heat]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"|[[Beriberi]], [[cirrhosis of liver]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Anemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Fever]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Paget's disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|[[Beriberi]], [[chronic alcoholism]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|[[Pregnancy]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"|[[Anxiety]], [[emotion]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|[[Cor pulmonale]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|[[Chronic alcoholism]], [[exercise]], [[fever]], [[heat]]
|-
|}

===Causes in Alphabetical Order===
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[Anemia]] 
*[[Anxiety]]
*[[Aortic regurgitation]] 
*[[Aortopulmonary window]]<ref name="pmid18480541">{{cite journal| author=Suvarna JC| title=Watson's water hammer pulse. | journal=J Postgrad Med | year= 2008 | volume= 54 | issue= 2 | pages= 163-5 | pmid=18480541 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18480541  }} </ref>
*[[Arteriovenous fistula]]
*[[Beriberi]] 
*[[Bradycardia]]
*[[Chronic alcoholism]]
*[[Cirrhosis of liver]]
*[[Complete heart block]] <ref name="pmid18480541">{{cite journal| author=Suvarna JC| title=Watson's water hammer pulse. | journal=J Postgrad Med | year= 2008 | volume= 54 | issue= 2 | pages= 163-5 | pmid=18480541 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18480541  }} </ref>
*[[Cor pulmonale]]
*[[Emotion]]<ref name="pmid18480541">{{cite journal| author=Suvarna JC| title=Watson's water hammer pulse. | journal=J Postgrad Med | year= 2008 | volume= 54 | issue= 2 | pages= 163-5 | pmid=18480541 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18480541  }} </ref>
*[[Exercise]]<ref name="pmid18480541">{{cite journal| author=Suvarna JC| title=Watson's water hammer pulse. | journal=J Postgrad Med | year= 2008 | volume= 54 | issue= 2 | pages= 163-5 | pmid=18480541 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18480541  }} </ref>
{{col-break|width=33%}}
*[[Fever]]
*[[Heat]]<ref name="pmid18480541">{{cite journal| author=Suvarna JC| title=Watson's water hammer pulse. | journal=J Postgrad Med | year= 2008 | volume= 54 | issue= 2 | pages= 163-5 | pmid=18480541 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18480541  }} </ref>
*[[Hyperthyroidism]] 
*[[Leaking aortic valve prosthesis]] <ref name="pmid18480541">{{cite journal| author=Suvarna JC| title=Watson's water hammer pulse. | journal=J Postgrad Med | year= 2008 | volume= 54 | issue= 2 | pages= 163-5 | pmid=18480541 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18480541  }} </ref>
*[[Mitral regurgitation]]<ref name="pmid18480541">{{cite journal| author=Suvarna JC| title=Watson's water hammer pulse. | journal=J Postgrad Med | year= 2008 | volume= 54 | issue= 2 | pages= 163-5 | pmid=18480541 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18480541  }} </ref> 
*[[Paget's disease]]
*[[Patent ductus arteriosus]]
*[[Pregnancy]]
*[[Rupture of sinus of valsalva]]<ref name="pmid18480541">{{cite journal| author=Suvarna JC| title=Watson's water hammer pulse. | journal=J Postgrad Med | year= 2008 | volume= 54 | issue= 2 | pages= 163-5 | pmid=18480541 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18480541  }} </ref>
*[[Systolic hypertension]]
*[[Thyrotoxicosis]]
*[[Truncus arteriosus]]<ref name="pmid18480541">{{cite journal| author=Suvarna JC| title=Watson's water hammer pulse. | journal=J Postgrad Med | year= 2008 | volume= 54 | issue= 2 | pages= 163-5 | pmid=18480541 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18480541  }} </ref>
*[[Ventricular septal defect]]<ref name="pmid18480541">{{cite journal| author=Suvarna JC| title=Watson's water hammer pulse. | journal=J Postgrad Med | year= 2008 | volume= 54 | issue= 2 | pages= 163-5 | pmid=18480541 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18480541  }} </ref>
{{col-end}}

==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==
*[[Aortic insufficiency physical examination|Aortic Insufficiency Physical Examination]]
*[[Blood hammer]]

==References==
{{Reflist|2}}

{{Circulatory system pathology}}
{{Symptoms and signs}}	

[[Category:Medical signs]]
[[Category:Signs and symptoms]]
[[Category:Cardiology]]
[[Category:Crowdiagnosis]]

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