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] 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)

Related Chapters

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Suvarna JC (2008). "Watson's water hammer pulse". J Postgrad Med. 54 (2): 163–5. PMID 18480541.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>

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