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Watson’s water hammer pulse is a powerful, hyperdynamic pulse caused by increased blood flow from the left ventricle and decreased outflow resistance. It can be felt in the limbs, while Corrigan’s pulse is sensed in the carotid artery. A water hammer is often associated with a leaky aortic valve, and can be caused by certain physiological conditions and medical conditions such as anemia and high blood pressure. Symptoms include muscle weakness, fatigue, shortness of breath, and chest pains. Pulse pressure may be a better prognostic indicator than systolic or diastolic blood pressure alone.
Watson’s water hammer pulse is a characteristic medical sign first described by Thomas Watson, MD in 1844. It is a pulse that is powerfully pulsating, similar in nature to the pounding of a water hammer. This hyperdynamic pulse occurs when more blood is pumped with each stroke of the left ventricle, the largest chamber of the heart. There is also a decrease in the blood’s outflow resistance, leading to a widening of the interval between the highest and lowest numbers of a blood pressure reading, called the pulse pressure. Corrigan’s pulse, named for Sir Dominic Corrigan, MD, refers to water hammer that is sensed in the carotid artery, while Watson’s water hammer pulse refers to one sensed peripherally in an arm or a leg.
A pulse is the rhythmic beat of blood flow due to the heartbeat. The pulse can be felt at many sites in the human body. Common sites for checking the pulse include in the neck, at the wrist, inside the elbow, behind the knee, and near the ankle joint. It can also be ascertained by assessing heartbeats directly with a stethoscope. Both pulse rate and quality reveal the underlying state of the heart and blood vessels.
The systolic and diastolic readings form the numerical boundaries of blood pressure. They represent opposite ends of the cardiac cycle and the highest and lowest blood pressure levels for a given individual. Pulse pressure is an indicator of the force the heart generates each time it contracts. In healthy adults, pulse pressure in a seated position is about 40, but 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 limbs and headaches. The patient may experience chest pains and palpitations. Cardiac arrhythmia, an irregular heartbeat, can occur due to reduced electrical conduction in the heart chambers.
A water hammer is most often associated with a leaky aortic valve. The aortic valve is the valve that normally prevents blood pumped out of the heart from flowing back into the heart. Aortic regurgitation or leak occurs when the valve doesn’t close properly, allowing blood to leak backwards through it. As a result, the left ventricle has to pump more blood than usual, gradually expanding due to the extra workload. Symptoms of aortic regurgitation can range from mild to severe, with some patients experiencing no symptoms for years.
Certain physiological conditions can cause water hammer, such as pregnancy, fever, and extreme anxiety. Other medical conditions can cause increased pulse pressure, including anemia, high blood pressure, and cirrhosis of the liver. 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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