What is the water hammer pulse?

Watson's water hammer pulse is a characteristic medical sign first described by Thomas Watson, MD in 1844. Water hammer pulse is a pulse that is powerfully pulsating, similar in nature to the tapping of a water hammer. This hyperdynamic pulse occurs when more blood is pumped with each stroke from the left ventricle, the heart's largest chamber. There is also a decrease in resistance to the outflow of blood, leading to a widening of the range between the highest and lowest numbers in a blood pressure reading, called pulse pressure. Corrigan's pulse, named for Sir Dominic Corrigan, MD, refers to a water hammer pulse detected in the carotid artery, while Watson's water hammer pulse corresponds to a water hammer pulse detected peripherally in an arm or leg.

A pulse is the rhythmic beating of blood flow due to the beating of the heart. The pulse can be felt at many places on the human body. Common sites to check the pulse include the neck, at the wrist, inside the elbow, behind the knee, and near the ankle joint. It can also be determined by evaluating the heartbeat directly with a stethoscope. Both pulse rate and quality reveal the underlying state of the heart and blood vessels.

The systolic and diastolic readings are the numerical limits of blood pressure. They represent opposite ends of the cardiac cycle and the highest and lowest levels of blood pressure for a given individual. Pulse pressure is an indicator of the force that the heart generates each time it contracts. In healthy adults, the pulse pressure in a sitting position is about 40, but it can rise to 100 during exercise. Some studies indicate that pulse pressure may be a better prognostic indicator of clinical outcome than systolic or diastolic blood pressure alone.

There are many symptoms associated with a water hammer pulse, the most common of which are muscle weakness and fatigue. Other associated symptoms include shortness of breath, swelling of the lower extremities, and headache. The patient may experience chest pains and palpitations. Cardiac arrhythmia, irregular heartbeat, can occur due to impaired electrical conduction in the heart chambers.

A water hammer pulse is most often associated with a leaky aortic valve. The aortic valve is the valve that normally prevents blood that has been pumped out of the heart from flowing back into the heart. Aortic regurgitation or leak occurs when the valve does not close properly, allowing blood to leak backwards through it. As a result, the left ventricle has to pump more blood than usual, with progressive expansion due to the additional workload. Symptoms of aortic regurgitation can range from mild to severe, with some patients having no symptoms for years.

Some physiological conditions can cause a water hammer pulse, such as pregnancy, fever, and extreme anxiety. Other medical conditions can cause increased pulse pressure, such as anemia, hypertension, and liver cirrhosis. It can also occur with an overactive thyroid gland. Abnormal connections between arteries and veins, called fistulas, can also produce this pulse.

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