What is Corrigan's pulse?

Corrigan's Pulse: A Clinical Sign of Aortic Regurgitation

Corrigan's pulse, also known as water-hammer pulse, is a bounding pulse characterized by a rapid rise and fall with wide pulse pressure, typically observed in patients with aortic regurgitation.

Definition and Characteristics

Corrigan's pulse is a physical examination finding with the following key features:

• Rapid forceful upstroke (rise) followed by a quick collapse (fall) of the arterial pulse
• Associated with wide pulse pressure (difference between systolic and diastolic blood pressure)
• Typically found in patients with moderate to severe aortic regurgitation
• Often described as "bounding" or "collapsing" in nature

Physiological Mechanism

The pathophysiology behind Corrigan's pulse relates directly to the hemodynamic consequences of aortic regurgitation:

1. During systole: Blood is ejected from the left ventricle into the aorta with increased stroke volume (due to regurgitant volume returning to the ventricle in diastole)
2. During diastole: Blood flows backward from the aorta into the left ventricle through the incompetent aortic valve
3. This backward flow causes:
   • Rapid decline in aortic pressure during diastole
   • Decreased diastolic blood pressure
   • Widened pulse pressure (elevated systolic, decreased diastolic)

Clinical Assessment

To properly assess for Corrigan's pulse:

1. Palpate the radial or carotid pulse
2. Note the rapid upstroke and quick collapse
3. The pulse may be more prominent when the patient's arm is elevated (as described in 1)
4. Measure blood pressure to confirm wide pulse pressure (typically >60 mmHg)

Associated Clinical Findings

Corrigan's pulse is often accompanied by other signs of aortic regurgitation:

• Visible precordial pulsations
• Early diastolic murmur at the left sternal edge
• Systolic hypertension with diastolic hypotension
• Bounding peripheral pulses

Clinical Significance

The presence of Corrigan's pulse has important clinical implications:

• It suggests hemodynamically significant aortic regurgitation 2
• Low diastolic blood pressure (<70 mmHg) in aortic regurgitation is associated with increased mortality risk 3
• The finding should prompt further cardiac evaluation, particularly echocardiography
• It may indicate the need for aortic valve repair or replacement in appropriate patients 4

Pitfalls and Considerations

When evaluating for Corrigan's pulse:

• Similar findings may be present in other high-output states (anemia, thyrotoxicosis, arteriovenous fistula)
• The intensity of the pulse can be affected by patient positioning and arterial compliance
• Medications (particularly vasodilators) may affect the pulse characteristics
• Elderly patients may have reduced arterial compliance, potentially masking this finding

Historical Context

Corrigan's pulse is named after Sir Dominic John Corrigan, an Irish physician who described this finding in patients with aortic valve insufficiency in the 19th century. The term "water-hammer pulse" refers to the similarity to the sensation felt when a Victorian toy called a water hammer is shaken.