Indian Journal of Medical & Health Sciences

31
Volume 4 Number 1, January - June 2017
Review Article DOI: https://dx.doi.org/10.21088/ijmhs.2347.9981.4117.5

Collapsing Pulse

Bakshi S.K.1, Mohammad Kamal Mahrous2, Nasser Rashid Alshukeili3

IJMHS (Jan-Jun 2017) 04 (1): 31-32 / ©Red Flower Publication Pvt. Ltd.

Abstract narrows with arm elevation. This fall in pulse

pressure was associated with an increased palpated
pulse. They attributed these changes to increased
Nothing is nor ever will be more significant in arterial compliance. Collapsing pulse (Watson’s
medical science, nor more necessary to it, than the water hammer pulse ) and Corrigan’s pulse refer to
observation of the pulse [1]. The characteristic pulse similar observations. However, the former usually
of aortic regurgitation (AR) is so familiar to the refers to measurement of a pulse on a limb, while the
observation of everyone that it may perhaps be latter refers to measurement of the pulse of the carotid
thought that its mode of origin must be so well known artery. “Watson’s water hammer pulse” is named
that there can be little room for further discussion on for Thomas Watson, who characterized it in 1844 [4].
the subject [2]. This review article elaborates the Corrigan’s pulse” is named for Sir Dominic Corrigan,
pathogenesis, causes, clinical approach to evaluate the Irish physician, who characterized it in 1832 [5].
collapsing pulse and its sensitivity and specificity .
Keywords: Collapsing Pulse; Water Hammer Pulse;
Watson Pulse; Pulsus Celer; Rhazes Pulse; Al Razi How to Check for Collapsing Pulse
Pulse; Cuming Pulse; Vieussens Pulse. Hold pulse with fingers of one hand, wrap the
fingers of other hand around forearm. Check any
pain in arm and shoulder. Lift arm up straight.
Introduction Collapsing pulse, felt as “water hammer” pulsation
in forearm [6].
Collapsing pulse also known as Watson’s water
hammer pulse, cannon ball pulse or pulsus celer is Pathogenesis
described in aortic regurgitation with a rapid
upstroke and descent [3]. The water hammer pulse is The collapsing or Corrigan or water-hammer pulse
believed to result from a wide pulse pressure. and the pistol-shot sound in the groin are time-
However, Warnes et al., using intra-arterial radial honored physical signs of marked aortic insufficiency
artery measurements in five patients with severe AR [7]. Collapsing pulse (Water hammer pulse) is a
demonstrated that the widened pulse pressure predominant feature in chronic aortic regurgitation
and is not seen in acute aortic regurgitation. This will
help in identifying the underlying cause e.g.
Author’s Affiliation: 1Associate Professor, Department of rheumatic etiology, collagen vascular disorders,
Medicine, Oman Medical College, Sohar, Oman. 2 Senior Marfan’s syndrome, syphilis, bicuspid aortic valve
Specialist 3Specialist, Department of Medicine, Rustaq Hospital,
Rustaq, Oman. or aortic root dilatation and excluding endocarditis,
aortic dissection, etc. which are mainly causing acute
Reprint Request: S.K. Bakshi, Associate Professor, aortic regurgitation. In chronic aortic regurgitation
Department of Medicine, Oman Medical College, Sohar, Oman. there is an increase in the left ventricular end-diastolic
E-mail: bakshisk@omc.edu.com volume (due to the regurgitation). This leads to
Received on: 11 March 2017
hemodynamic compensation in the form of chamber
Accepted on: 20 March 2017 dilatation and eccentric hypertrophy; the latter being
Indian Journal of Medical and Health Sciences / Volume 4 Number 1/ January - June 2017
32 Bakshi S.K. et. al. / Collapsing Pulse

attained through replication of sarcomeres in series Causes of collapsing pulse

and elongation of the myocytes and myocardial fibers The causes of collapsing pulse are summarized in
[8]. Table 1 [9-11].
Table 1: Causes of collapsing pulse [9-11]

S. No. Etiology Examples

1. Hyperkinetic circulatory states After exercise, Sepsis, Severe anaemia, Fever, Pregnancy, Liver
cirrhosis, Thyrotoxicosis , Beriberi, Paget’s disease of the bone.
2. Conditions with aortic run-off Chronic aortic regurgitation, PDA, Rupture of sinus of vasalva into the
right chambers and arterio-venous fistula .
3. Cyanotic congenital heart disease Truncus arteriosus with truncal “run-off into PA or truncal
insufficiency , pulmonary atresia with broncho- pulmonoray collaterals,
Tetralogy of Fallot with broncho - pulmonary collaterals/associated
PDA/associated AR or after Blalock Taussig (BT) shunt ( systemic
artery to pulmonary artery ) .

Approach to A Case of Collapsing Pulse References

History is an important tool in such cases in two
ways. First, prior throat infection with major and 1. Sexonia H. Tractatcus triplex de pulsibus
minor Duke’ criteria plus positive throat culture or (Frankfurt:1604).
high ASO titre may be of help in establishing a 2. Galabin AL. On the causation of the water hammer
rheumatic cause of chronic aortic regurgitation. pulse and its transformation in different arteries as
Second, history of recurrent respiratory tract illustrated by the graphic method. Med. Chir Trans.
infections from early infancy and clinical 1876; 59:361-388.
examination may help in diagnosis of ventricular 3. Dickey RA. The Corrigan sign. JAMA 1969;209:419.
septal defect, truncus arteriosus, patent ductus 4. Warnes CA, Harris PC, Fritts HW. Effect of elevating
arteriosus and aorto-pulmonary window with aortic the wrist on the radial pulse in aortic regurgitation:
regurgitation and such cases may also require 2-D Corrigan revisited. Am J Cardiol 1983; 51:1551-53.
Echocardiography. 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:
Specificity and Sensitivity of Collapsing Pulse 225-245.
Babu et al have noted that in the diagnosis of AR, 6. Oxford Handbook of Clinical Medicine 2014. 9th
the specificity of collapsing pulse is 16% and Edition page 36. Edited by Longmore M et al.
sensitivity is 38-95% respectively depending upon Published by Oxford University Press Inc., New York.
the severity of AR. In mild to moderate AR the 7. Palfrey FW. Auscultation of the Corrigan or Water-
sensitivity is 85%, in moderately severe to severe AR Hammer Pulse. NEJM 1952; 247:771- 772.
the sensitivity is 100% and in indeterminate severe
8. Bonow RO, Braunwald E. Valvular heart disease. In :
AR the sensitivity is 38-95%. Zipes DP, LibbyP, Bonow RO, Braunwald E .
The sensitivity was categorized as indeterminate Braunwald’s heart disease. 7 th ed. Elsevier
when the report provided insufficient information Saunders: Philadelphia; 2005.p.1553-632.
about this variable. The overall specificity is only 9. Cardiology Explained 2004. 1st Edition page 7. Edited
16% for all degrees of AR [12]. Babu et al also report by Ashley EA and Niebauer J. Published by
that the clinical sign carries a negative predictive Remedica London UK.
value of 73% for any degree of AR and 95% for severe 10. www. afghanheart.wordpress.com. Accessed on 01
AR [13]. March 2017.
11. Coats C, Elliott P. British Journal of Hospital
Medicine 2012; 73(5): 78- 80.
Source of Support
12. Babu AN, Kymes SM, Carpenter Fryer SM. Eponyms
None and the diagnosis of aortic regurgitation: What says
the evidence? Ann Intern Med 2003; 138:736-42.

Conflict of Interest 13. Babu AN, Bitar SR, Kymes SM, Isenberg C. Utility of
the collapsing pulse in screening for aortic
None insufficiency. J Gen Intern Med 2001; 16 (Suppl.1):115.

Indian Journal of Medical and Health Sciences / Volume 4 Number 1/ January - June 2017