Do regurgitant valves cause a water hammer pulse?

From the Guidelines

Regurgitant valves, specifically those with aortic regurgitation (AR), can cause a water hammer pulse. This condition is characterized by a rapid rise and fall in arterial pressure, creating a bounding pulse that collapses suddenly, and is most prominently felt in the radial artery. The water hammer pulse, also known as Corrigan's pulse or collapsing pulse, occurs because in aortic regurgitation, blood flows backward into the left ventricle during diastole, causing a wide pulse pressure (elevated systolic pressure with low diastolic pressure) 1. According to the 2020 ACC/AHA guideline for the management of patients with valvular heart disease, acute aortic regurgitation may result from abnormalities of the valve or aorta, and can lead to severe pulmonary congestion and low forward cardiac output 1. Key characteristics of aortic regurgitation include:

• Jet width ≥65% of LVOT
• Vena contracta >0.6 cm
• Holodiastolic flow reversal in the proximal abdominal aorta
• Regurgitant volume ≥60 mL/beat
• Regurgitant fraction ≥50%
• ERO ≥0.3 cm²
• Angiography grade 3 to 4 1. Other regurgitant valves like mitral, tricuspid, or pulmonic regurgitation do not typically cause water hammer pulse because they don't directly affect the pressure dynamics in the systemic arterial circulation in the same way. The severity of the water hammer pulse generally correlates with the severity of aortic regurgitation, making it a useful clinical sign for assessment. In clinical practice, it is essential to accurately diagnose and manage patients with aortic regurgitation to prevent complications and improve outcomes 1.

From the Research

Regurgitant Valves and Water Hammer Pulse

• Regurgitant valves, particularly aortic regurgitation, can lead to various cardiovascular complications, but the direct relationship between regurgitant valves and water hammer pulse is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
• Aortic regurgitation is characterized by retrograde blood flow from the aorta to the left ventricle, which can result in increased left ventricular volume and potentially lead to heart failure symptoms 2.
• The management of aortic regurgitation involves medical therapy, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and potentially calcium-channel blockers, as well as surgical intervention 2, 5.
• Beta-blockers have been studied in the context of aortic regurgitation, with some evidence suggesting a potential beneficial association in patients with severe aortic regurgitation 4, 6.
• However, the specific relationship between regurgitant valves and water hammer pulse is not addressed in the provided studies, and therefore, it is unclear whether regurgitant valves can cause a water hammer pulse 2, 3, 4, 5, 6.

Pathophysiology and Clinical Manifestations

• Aortic regurgitation can lead to increased left ventricular volume, which can result in heart failure symptoms and potentially affect the cardiovascular system in various ways 2, 5.
• The pathophysiology of aortic regurgitation involves retrograde blood flow from the aorta to the left ventricle, which can lead to increased wall stress and potentially result in left ventricular remodeling 2.
• Clinical manifestations of aortic regurgitation can include heart failure symptoms, such as dyspnea and fatigue, as well as signs of increased left ventricular volume, such as a widened pulse pressure 2, 5.

Medical Therapy and Management

• Medical therapy for aortic regurgitation involves the use of vasodilators, such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, to reduce afterload and slow the progression of left ventricular dysfunction 2, 5.
• Beta-blockers have been studied in the context of aortic regurgitation, with some evidence suggesting a potential beneficial association in patients with severe aortic regurgitation 4, 6.
• Surgical intervention, such as aortic valve replacement, is often necessary in patients with severe aortic regurgitation or those who have developed heart failure symptoms 2, 5.