Visible carotid pulsation (Corrigan pulse)

Specialty: Cardiovascular.

• carotid water hammer pulse
• saltatory neck pulsation
• visible hyperdynamic pulse

Why it occurs

• Chronic severe aortic valve insufficiency
• Large patent ductus arteriosus
• Systemic large-caliber arteriovenous fistula
• Uncontrolled thyrotoxicosis
• Severe chronic anemia
• Severe mitral regurgitation associated with aortic reflux

Initial workup

Two-dimensional transthoracic echocardiogram and color Doppler to quantitatively evaluate the aortic valve, measure ejection velocity, stroke volume, left ventricular end-diastolic diameter (>70 mm is an alarm criterion for advanced remodeling) and end-systolic diameter (>50 mm), quantify the regurgitant jet by continuous flow PHT and assess the LVEF; 12-lead electrocardiogram; Chest x-ray.

Standard management

• Ramipril — ACEI to reduce peripheral vascular resistance, optimize cardiac output and reduce the speed of ventricular dilation; 5 to 10 mg once daily orally, titrated according to blood pressure
• Nifedipine — prolonged-release dihydropyridine calcium antagonist to promote systemic arterial vasodilation; 30 to 60 mg per day orally
• Furosemide — loop diuretic indicated if there are clear signs of pulmonary or systemic fluid overload; 20 to 40 mg orally per day
• Carvedilol (beta blocker that should be used with extreme caution in severe aortic insufficiency because the associated bradycardia prolongs diastole and increases regurgitant volume; initiation with very low doses of 3,125 mg every 12 hours if there is demonstrated systolic dysfunction).