Quincke capillary pulsation

Specialty: Cardiovascular.

• Quincke sign
• visible nail capillary pulse

Why it occurs

• Chronic severe aortic valve insufficiency
• Hyperdynamic circulatory states (severe thyrotoxicosis, severe anemia, pregnancy)
• Large caliber systemic arteriovenous fistula
• Wet beriberi (severe thiamine deficiency with hyperdynamic heart failure)
• Persistence of the large ductus arteriosus with shunt from left to right

Initial workup

Transthoracic Doppler echocardiogram to diagnose and quantify the severity of aortic regurgitation (measuring regurgitant jet width, hemipressure time (PHT <200 ms indicates severity), regurgitant volume, and holodiastolic flow reversal in the descending aorta); Cardiac Magnetic Resonance (CMR) if echocardiographic images are doubtful to quantify the regurgitation fraction; 12-lead electrocardiogram to identify signs of left ventricular volume overload (deep Q waves in lateral leads and left ventricular hypertrophy).

Standard management

• Ramipril — ACEI indicated in chronic aortic insufficiency to reduce afterload, reduce regurgitant volume and slow down the progression of left ventricular dilation; 5 to 10 mg once daily orally, depending on the patient's blood pressure
• Nifedipine — long-acting dihydropyridine calcium antagonist, useful for controlling afterload and reducing wall tension if the patient is hypertensive; 30 to 60 mg once daily orally
• Furosemide — loop diuretic useful for controlling associated pulmonary congestive symptoms; 20 to 40 mg orally per day
• Thiamine (vitamin B1, specifically indicated if the confirmed etiology is wet beriberi; 100 mg intravenously or orally daily).