Watson's water hammer pulse, also known as Corrigan's pulse or collapsing pulse, is the medical

sign A sign is an object, quality, event, or entity whose presence or occurrence indicates the probable presence or occurrence of something else. A natural sign bears a causal relation to its object—for instance, thunder is a sign of storm, or me ...

(seen in aortic regurgitation) which describes a

pulse In medicine, the pulse refers to the rhythmic pulsations (expansion and contraction) of an artery in response to the cardiac cycle (heartbeat). The pulse may be felt ( palpated) in any place that allows an artery to be compressed near the surfac ...

that is bounding and forceful, rapidly increasing and subsequently collapsing, as if it were the sound of a

water hammer Hydraulic shock ( colloquial: water hammer; fluid hammer) is a pressure surge or wave caused when a fluid in motion is forced to stop or change direction suddenly: a momentum change. It is usually observed in a liquid but gases can also be aff ...

that was causing the pulse.

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 In cardiac physiology, cardiac output (CO), also known as heart output and often denoted by the symbols Q, \dot Q, or \dot Q_ , edited by Catherine E. Williamson, Phillip Bennett is the volumetric flow rate of the heart's pumping output: tha ...

, (as per the Frank–Starling mechanism) so that

systolic blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...

increases and a stronger

pulse pressure Pulse pressure is the difference between systolic and diastolic blood pressure. It is measured in millimeters of mercury (mmHg). It represents the force that the heart generates each time it contracts. Healthy pulse pressure is around 40 ...

can be palpated.

Causes

Water hammer pulse is commonly found when a patient has

aortic regurgitation Aortic regurgitation (AR), also known as aortic insufficiency (AI), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. As a conse ...

. It can also be seen in other conditions which are associated with a

hyperdynamic circulation Hyperdynamic circulation is abnormally increased circulatory volume. Systemic vasodilation and the associated decrease in peripheral vascular resistance results in decreased pulmonary capillary wedge pressure and decreased blood pressure, presentin ...

. A more comprehensive list of causes follows: * Physiological **

Fever Fever or pyrexia in humans is a symptom of an anti-infection defense mechanism that appears with Human body temperature, body temperature exceeding the normal range caused by an increase in the body's temperature Human body temperature#Fever, s ...

Pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...

* Cardiac lesions **

Aortic regurgitation Aortic regurgitation (AR), also known as aortic insufficiency (AI), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. As a conse ...

Patent ductus arteriosus Patent ductus arteriosus (PDA) is a medical condition in which the ''ductus arteriosus'' fails to close after childbirth, birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs from the aorta, which has a h ...

Systolic hypertension In medicine, systolic hypertension is defined as an elevated systolic blood pressure (SBP). If the systolic blood pressure is elevated (>140) with a normal (<90) diastolic blood pressure (DBP), it is called isolated systolic hypertension. Eighty p ...

Bradycardia Bradycardia, also called bradyarrhythmia, is a resting heart rate under 60 beats per minute (BPM). While bradycardia can result from various pathological processes, it is commonly a physiological response to cardiovascular conditioning or due ...

** Aortopulmonary window **

Aneurysm of sinus of Valsalva Aneurysm of the aortic sinus, also known as the sinus of Valsalva, is a rare abnormality of the aorta, the largest artery in the body. The aorta normally has three small pouches that sit directly above the aortic valve (the sinuses of Valsalv ...

* Syndromes or high-output states **

Anemia Anemia (also spelt anaemia in British English) is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin availabl ...

Cor pulmonale Pulmonary heart disease, also known as cor pulmonale, is the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance (such as from pulmonic stenosis) or high blood pressure in the lungs. Chroni ...

** Cirrhosis of liver **

Beriberi Thiamine deficiency is a medical condition of low levels of thiamine (vitamin B1). A severe and chronic form is known as beriberi. The name beriberi was possibly borrowed in the 18th century from the Sinhalese phrase (bæri bæri, “I canno ...

Thyrotoxicosis Hyperthyroidism is a endocrine disease in which the thyroid gland produces excessive amounts of thyroid hormones. Thyrotoxicosis is a condition that occurs due to elevated levels of thyroid hormones of any cause and therefore includes hyperth ...

Arteriovenous fistula An arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arteri ...

** Paget's disease * Other causes **

Chronic alcoholism Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records. The World Hea ...

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 Carotid artery may refer to: * Common carotid artery, often "carotids" or "carotid", an artery on each side of the neck which divides into the external carotid artery and internal carotid artery * External carotid artery, an artery on each side of ...

. * "Corrigan's pulse" is named for Sir

Dominic Corrigan Sir Dominic John Corrigan, 1st Baronet (2 December 1802 – 1 February 1880), was an Irish physician, known for his original observations in heart disease. The abnormal "collapsing" pulse of aortic insufficiency, aortic valve insufficiency is na ...

, the Irish physician, who characterized it in 1832.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. * "Watson's water hammer pulse" is named for Thomas Watson, who characterized it in 1844.

References

{{Cardiovascular system symptoms and signs Symptoms and signs: Cardiac

Diagnosis

Causes

Eponym

See also

References