Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 2961  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  Article in PDF (63 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  References

 Article Access Statistics
    Viewed3179    
    Printed88    
    Emailed0    
    PDF Downloaded199    
    Comments [Add]    

Recommend this journal


 


 
LETTER
Year : 2008  |  Volume : 54  |  Issue : 4  |  Page : 335

Watson's water hammer pulse


Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, 9500 Euclid Avenue A50, Cleveland-44195, Ohio, USA

Correspondence Address:
A Khasnis
Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, 9500 Euclid Avenue A50, Cleveland-44195, Ohio
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.43524

Rights and Permissions




How to cite this article:
Khasnis A, Chatterjee S. Watson's water hammer pulse. J Postgrad Med 2008;54:335

How to cite this URL:
Khasnis A, Chatterjee S. Watson's water hammer pulse. J Postgrad Med [serial online] 2008 [cited 2019 Aug 24];54:335. Available from: http://www.jpgmonline.com/text.asp?2008/54/4/335/43524


Sir,

We read with great interest the excellent comprehensive review titled "Watson's water hammer pulse" published in your journal. [1] We would like to draw attention to some additional clinically relevant information regarding this physical sign.

Babu et al. , have noted that the sensitivity of water hammer pulse in the diagnosis of aortic regurgitation (AR) varies from 38-95% depending upon the severity of AR. [2] The overall specificity is only 16% for all degrees of AR. They also report that the clinical sign carries a negative predictive value of 73% for any degree of AR and 95% for severe AR. [3] This indicates that the absence of water hammer pulse makes the diagnosis of AR less likely. The low specificity found in this study indicates that this sign may be seen in conditions other than AR and that it is probably most useful when seen in conjunction with other findings of AR on physical examination.

The water hammer pulse is believed to result from a wide pulse pressure. However, Warnes et al. , using intra-arterial radial artery measurements in five patients with severe AR demonstrated that the widened pulse pressure narrows with arm elevation. This fall in pulse pressure was associated with an increased palpated pulse. They attributed these changes to increased arterial compliance. [4] The pulse pressure is not wide to begin with in patients with acute AR. Therefore, a further fall in pulse pressure with limb elevation may not be as easily clinically appreciable as in patients with chronic AR. This can mask the water hammer pulse in patients with acute AR.

 
 :: References Top

1.Suvarna JC. Watson's water hammer pulse. J Postgrad Med 2008;54:163-5.  Back to cited text no. 1  [PUBMED]  Medknow Journal
2.Babu AN, Kymes SM, Carpenter Fryer SM. Eponyms and the diagnosis of aortic regurgitation: What says the evidence? Ann Intern Med 2003;138:736-42.   Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Babu AN, Bitar SR, Kymes SM, Isenberg C. Utility of the collapsing pulse in screening for aortic insufficiency. J Gen Intern Med 2001;16:115.  Back to cited text no. 3    
4.Warnes CA, Harris PC, Fritts HW. Effect of elevating the wrist on the radial pulse in aortic regurgitation: Corrigan revisited. Am J Cardiol 1983;51:1551-3.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]




 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow