Watson's water hammer pulse

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

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.

Common Causes

• Aortic regurgitation

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
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	No underlying causes

Physiological:

• Fever
• Pregnancy

Cardiac lesions:

• Aortic regurgitation
• Patent ductus arteriosus
• Systolic hypertension
• Bradycardia
• Aortopulmonary window
• Rupture of the sinus of valsalva into heart chambers

Syndromes or High output states:

• Anemia
• Cor pulmonale
• Cirrhosis of liver
• Beriberi
• Thyrotoxicosis
• Arteriovenous fistula
• Paget's disease

Other causes:

• Chronic alcoholism

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
• Blood hammer

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