Corrigan's pulse visible

Specialty: Cardiovascular.

• visible water hammer pulse
• visiblesaltatory arterial beat of the temporal or radial artery

Why it occurs

• Chronic severe aortic valve insufficiency
• Marked hyperdynamic states (severe thyrotoxicosis, severe anemia)
• Massive peripheral arteriovenous fistula
• Persistence of the ductus arteriosus
• Maintained high fever with extreme peripheral vasodilation

Initial workup

Transthoracic Doppler echocardiogram to quantify the degree of aortic insufficiency, evaluate left ventricular diameters and volumes, pulmonary systolic pressure, and estimate myocardial ejection function; Chest x-ray to assess the cardiothoracic index and the presence of lines of pulmonary venocapillary congestion; 12-lead electrocardiogram to identify signs of advanced left ventricular hypertrophy with diastolic overload pattern.

Standard management

• Enalapril — ACEI to chronically reduce afterload, reducing the regurgitant volume through the aortic valve; 5 to 10 mg twice daily orally
• Amlodipine — dihydropyridine calcium antagonist to induce vasodilation and control of blood pressure in patients with aortic insufficiency; 5 to 10 mg once daily orally
• Furosemide — loop diuretic if there are clear data of volume overload or pulmonary edema; 20 to 40 mg orally per day
• Carvedilol (beta blocker indicated only if the patient is stable and has concomitant ventricular systolic dysfunction, starting at low doses of 3,125 mg every 12 hours and under close monitoring).