Watson's water hammer pulse

Last updated April 28, 2019

Watson's water hammer pulse, also known as Corrigan's pulse or collapsing pulse, is the medical sign which describes a pulse that is bounding and forceful,^[1] rapidly increasing and subsequently collapsing,^[2] as if it were the sound of a waterhammer that was causing the pulse. A water hammer was a Victorian toy in which a tube was half filled with fluid, the remainder being a vacuum. Each time the tube was inverted or shaken, the impact of the fluid at each end would sound like a hammer blow.^[3]

In medicine, a pulse represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed near the surface of the body, such as at the neck, wrist, at the groin, behind the knee, near the ankle joint, and on foot. Pulse is equivalent to measuring the heart rate. The heart rate can also be measured by listening to the heart beat by auscultation, traditionally using a stethoscope and counting it for a minute. The radial pulse is commonly measured using three fingers. This has a reason: the finger closest to the heart is used to occlude the pulse pressure, the middle finger is used get a crude estimate of the blood pressure, and the finger most distal to the heart is used to nullify the effect of the ulnar pulse as the two arteries are connected via the palmar arches. The study of the pulse is known as sphygmology.

Water hammer pressure surge when a fluid is forced to stop or change direction suddenly

Hydraulic shock is a pressure surge or wave caused when a fluid, usually a liquid but sometimes also a gas, in motion is forced to stop or change direction suddenly; a momentum change. This phenomenon commonly occurs when a valve closes suddenly at an end of a pipeline system, and a pressure wave propagates in the pipe.

In cardiovascular physiology, stroke volume (SV) is the volume of blood pumped from the left ventricle per beat. Stroke volume is calculated using measurements of ventricle volumes from an echocardiogram and subtracting the volume of the blood in the ventricle at the end of a beat from the volume of blood just prior to the beat. The term stroke volume can apply to each of the two ventricles of the heart, although it usually refers to the left ventricle. The stroke volumes for each ventricle are generally equal, both being approximately 70 mL in a healthy 70-kg man.

Pulse pressure is the difference between the systolic and diastolic blood pressure.

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 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.

Causes

Water hammer pulse is commonly found when a patient has aortic regurgitation. It can also be seen in other conditions which are associated with a hyperdynamic circulation. A more comprehensive list of causes follows:

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, presenting usually with a collapsing pulse, but sometimes a bounding pulse. In effort to compensate the heart will increase cardiac output and heart rate, which accounts for the increased pulse pressure and sinus tachycardia. The condition sometimes accompanies septic shock, preeclampsia, and other physiological and psychiatric conditions.

Physiological
- Fever
- Pregnancy
Cardiac lesions
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".
Bradycardia is a condition typically defined wherein an individual has a resting heart rate of under 60 beats per minute (BPM) in adults. Bradycardia typically does not cause symptoms until the rate drops below 50 BPM. When symptomatic, it may cause fatigue, weakness, dizziness, sweating, and at very low rates, fainting.
Aortopulmonary window refers to a congenital heart defect similar in some ways to persistent truncus arteriosus. Persistent truncus arteriosus involves a single valve; aortopulmonary window is a septal defect.
Syndromes or high-output states
Anemia is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen. When anemia comes on slowly, the symptoms are often vague and may include feeling tired, weakness, shortness of breath or a poor ability to exercise. Anemia that comes on quickly often has greater symptoms, which may include confusion, feeling like one is going to pass out, loss of consciousness, or increased thirst. Anemia must be significant before a person becomes noticeably pale. Additional symptoms may occur depending on the underlying cause.
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 arterial aneurysm.
Paget's disease of bone is a condition involving cellular remodeling and deformity of one or more bones. The affected bones show signs of dysregulated bone remodeling at the microscopic level, specifically excessive bone breakdown and subsequent disorganized new bone formation. These structural changes cause the bone to weaken, which may result in deformity, pain, fracture, or arthritis of associated joints. The exact cause is unknown, although leading theories indicate both genetic and acquired factors. Paget's disease may affect any one or multiple bones of the body, but never the entire skeleton, and does not spread from bone to bone. Rarely, a bone affected by Paget's disease can transform into a malignant bone cancer.
Other causes
- Chronic alcoholism

Fever, also known as pyrexia and febrile response, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using values between 37.5 and 38.3 °C. The increase in set point triggers increased muscle contractions and causes a feeling of cold. This results in greater heat production and efforts to conserve heat. When the set point temperature returns to normal, a person feels hot, becomes flushed, and may begin to sweat. Rarely a fever may trigger a febrile seizure. This is more common in young children. Fevers do not typically go higher than 41 to 42 °C.

Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy can occur by sexual intercourse or assisted reproductive technology. Childbirth typically occurs around 40 weeks from the last menstrual period (LMP). This is just over nine months, where each month averages 31 days. When measured from fertilization it is about 38 weeks. An embryo is the developing offspring during the first eight weeks following fertilization, after which, the term fetus is used until birth. Symptoms of early pregnancy may include missed periods, tender breasts, nausea and vomiting, hunger, and frequent urination. Pregnancy may be confirmed with a pregnancy test.

Patent ductus arteriosus (PDA) is a condition wherein the ductus arteriosus fails to close after birth.

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.^[1]

"Corrigan's pulse" is named for Sir Dominic Corrigan, the Irish physician, who characterized it in 1832.^[4]^[5]
"Watson's water hammer pulse" is named for Thomas Watson, who characterized it in 1844.^[1]

Related Research Articles

Aortic stenosis is the narrowing of the exit of the left ventricle of the heart, such that problems result. It may occur at the aortic valve as well as above and below this level. It typically gets worse over time. Symptoms often come on gradually with a decreased ability to exercise often occurring first. If heart failure, loss of consciousness, or heart related chest pain occurs due to AS the outcomes are worse. Loss of consciousness typically occurs with standing or exercise. Signs of heart failure include shortness of breath especially when lying down, at night, or with exercise, and swelling of the legs. Thickening of the valve without narrowing is known as aortic sclerosis.

Heart sounds are the noises generated by the beating heart and the resultant flow of blood through it. Specifically, the sounds reflect the turbulence created when the heart valves snap shut. In cardiac auscultation, an examiner may use a stethoscope to listen for these unique and distinct sounds that provide important auditory data regarding the condition of the heart.

The aortic valve is a valve in the human heart between the left ventricle and the aorta. It is one of the two semilunar valves of the heart, the other being the pulmonary valve. The heart has four valves and the other two are the mitral and the tricuspid valves. The aortic valve normally has three cusps or leaflets, although in 1–2% of the population it is found to congenitally have two leaflets. The aortic valve is the last structure in the heart the blood travels through before flowing through the systemic circulation.

Heart murmurs are heart sounds produced when blood flows across one of the heart valves that are loud enough to be heard with a stethoscope.

A sphygmomanometer, also known as a blood pressure meter, blood pressure monitor, or blood pressure gauge, is a device used to measure blood pressure, composed of an inflatable cuff to collapse and then release the artery under the cuff in a controlled manner, and a mercury or mechanical manometer to measure the pressure. It is always used in conjunction with a means to determine at what pressure blood flow is just starting, and at what pressure it is unimpeded. Manual sphygmomanometers are used in conjunction with a stethoscope.

dextro-Transposition of the great arteries congenital heart disease characterized by complete inversion of the great vessels where the aorta incorrectly arises from the right ventricle and the pulmonary artery incorrectly arises from the left ventricle

dextro-Transposition of the great arteries, sometimes also referred to as complete transposition of the great arteries, is a birth defect in the large arteries of the heart. The primary arteries are transposed.

Aortic insufficiency (AI), also known as aortic regurgitation (AR), 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 consequence, the cardiac muscle is forced to work harder than normal.

The jugular venous pressure is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease. Classically three upward deflections and two downward deflections have been described.

Cyanotic heart defect is a group-type of congenital heart defect (CHD) that occurs due to deoxygenated blood bypassing the lungs and entering the systemic circulation or a mixture of oxygenated and unoxygenated blood entering the systemic circulation. It is caused by structural defects of the heart, or any condition which increases pulmonary vascular resistance. The result being the development of collateral circulation.

Mitral regurgitation (MR), Mitral insufficiency, or mitral incompetence, is a form of valvular heart disease in which the mitral valve does not close properly when the heart pumps out blood. It is the abnormal leaking of blood backwards from the left ventricle, through the mitral valve, into the left atrium, when the left ventricle contracts, i.e. there is regurgitation of blood back into the left atrium. MR is the most common form of valvular heart disease.

Coarctation of the aorta congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts.

Coarctation of the aorta, also called aortic narrowing, is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus inserts. The word "coarctation" means narrowing. Coarctations are most common in the aortic arch. The arch may be small in babies with coarctations. Other heart defects may also occur when coarctation is present, typically occurring on the left side of the heart. When a patient has a coarctation, the left ventricle has to work harder. Since the aorta is narrowed, the left ventricle must generate a much higher pressure than normal in order to force enough blood through the aorta to deliver blood to the lower part of the body. If the narrowing is severe enough, the left ventricle may not be strong enough to push blood through the coarctation, thus resulting in lack of blood to the lower half of the body. Physiologically its complete form is manifested as interrupted aortic arch.

Valvular heart disease is any cardiovascular disease process involving one or more of the four valves of the heart. These conditions occur largely as a consequence of aging, but may also be the result of congenital (inborn) abnormalities or specific disease or physiologic processes including rheumatic heart disease and pregnancy.

Pulsus bisferiens, also known as biphasic pulse, is an aortic waveform with two peaks per cardiac cycle, a small one followed by a strong and broad one. It is a sign of problems with the aortic valve, including aortic stenosis and aortic regurgitation, as well as hypertrophic cardiomyopathy causing subaortic stenosis.

The Jatene procedure, arterial switch operation or arterial switch, is an open heart surgical procedure used to correct dextro-transposition of the great arteries (d-TGA); its development was pioneered by Canadian cardiac surgeon William Mustard and it was named for Brazilian cardiac surgeon Adib Jatene, who was the first to use it successfully. It was the first method of d-TGA repair to be attempted, but the last to be put into regular use because of technological limitations at the time of its conception. Use of the arterial switch is historically preceded by two atrial switch methods: the Senning and Mustard procedures.

The following outline is provided as an overview of and topical guide to cardiology:

Pulse wave velocity (PWV) is the velocity at which the blood pressure pulse propagates through the circulatory system, usually an artery or a combined length of arteries. PWV is used clinically as a measure of arterial stiffness and can be readily measured non-invasively in humans, with measurement of carotid to femoral PWV (cfPWV) being the recommended method. cfPWV is highly reproducible, and predicts future cardiovascular events and all-cause mortality independent of conventional cardiovascular risk factors. It has been recognized by the European Society of Hypertension as an indicator of target organ damage and a useful additional test in the investigation of hypertension.

The cardiovascular examination is a portion of the physical examination that involves evaluation of the cardiovascular system. The exact contents of the examination will vary depending on the presenting complaint but a complete examination will involve the heart, lungs, belly and the blood vessels.

Sir Thomas Watson, 1st Baronet, was a British physician who is primarily known for describing the water hammer pulse found in aortic regurgitation in 1844. He was President of the Royal College of Physicians from 1862 to 1866.

References

1 2 3 Suvarna JC (2008). "Watson's water hammer pulse". J Postgrad Med. 54 (2): 163–5. doi:10.4103/0022-3859.40791. PMID 18480541.
↑ Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6.
↑ https://www.youtube.com/watch?v=Kb6feUfHgAU
↑ synd/3006 at Who Named It?
↑ 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.

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.

[pmid18480541-1] 1 2 3 Suvarna JC (2008). "Watson's water hammer pulse". J Postgrad Med. 54 (2): 163–5. doi:10.4103/0022-3859.40791. PMID 18480541.

[agabegi2nd-2] Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7153-6.

[3] ttps://www.youtube.com/watch?v=Kb6feUfHgAU

[4] synd/3006 at Who Named It?

[5] 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.