Corrigan pulse

Description

Corrigan pulse describes the excessive visible pulsations of arteries in patients with aortic valve insufficiency, most obvious in the head and superior extremity arteries when the patient is upright; in particular, the subclavian, carotid, temporal, brachial, and palmar arteries.

It is named after Sir Dominic John Corrigan, who described the visible arterial pulsations of aortic regurgitation, while comprehensively explaining the pathophysiology, diagnosis, management, and prognosis of the disease in his 1832 publication ‘On permanent patency of the mouth of the aorta, or inadequacy of the aortic valves’.

Corrigan pulse is often incorrectly used to described the ‘water-hammer pulse’ palpated in patients with aortic regurgitation. However, the water-hammer description was first used by Sir Thomas Watson in his lecture on aortic valve insufficiency (1837; published in 1842).

History of the Corrigan pulse

1715 – Vieussens (1641-1715) was the first to accurately describe the pathology of mitral stenosis. He also described the physical manifestations observed in aortic incompetence in his work ‘Novum vasorum corporis humani systema‘ (1705), and provided the first description of the associated pulse as:

very full, very fast, hard and unequal, and so strong the arteries on both sides struck the fingers like a tense cord vibrating violently” (translated)

-Vieussens 1715, in Traite nouveau de la structure et des causes du mouvement naturel du coeur.

1827, 1829 – Thomas Hodgkin (1798-1866) presented a number of cases with aortic incompetence and highlighted the clinical manifestations to the Hunterian Society twice, which were later published in the London Medical Gazette (1829). In his 1827 presentation, he noted a male patient with:

…Some of the contractions of the heart were lost at the wrist. The pulsations of the carotids were strong, and attended with bruit de scie…”

Hodgkin 1827

Hodgkin later presented in 1829 a case of his friend Dr Cox, a 28 year-old man who was relatively athletic, but experienced heart palpitations throughout his life and also “constant inordinate action of all the arteries of the body”. Some of the observations on the pulse and murmur by Hodgkin include:

Beside the general and inordinately violent arterial action, which was very rapid and frequent, though perfectly regular, there was a remarkable thrill in the pulse and the carotids were seen violently beating on both sides. The contractions of the ventricles were marked by strong impulse, and a constant bruit de scie, which presented this peculiarity, that it was double, attending the systole as well as the diastole…”

Hodgkin 1829

1832 – Sir Dominic John Corrigan (1802-1880) described the exaggerated visible pulsations of head and upper extremity arteries, in addition to ‘Bruit de soufflet’ and ‘frémissement’ as the three physical signs of aortic regurgitation in the Edinburgh Medical and Surgical Journal. He also briefly mentioned the ‘full pulse’ of aortic regurgitation in passing.

• He observed the visible abrupt distension and collapse of the carotid, head, and superior extremity arteries in patients with permanent patency of the aortic mouth. Sir Corrigan explained that in aortic valve insufficiency, the ascending aorta and branching arteries lessen in diameter as blood regurgitates back into the left ventricle, which then suddenly and greatly dilates with ventricular contraction.
• Bruit de soufflet (bellows murmur) was described by Corrigan as a pathognomonic sign best heard at the heart base and the great vessels. The accompanying frémissement was described as a palpated thrill in the carotid and subclavian arteries.

1837 – Sir Thomas Watson (1792 – 1882) likened the characteristic palpable pulse of AR to a Victorian toy called a water-hammer; which imparted to a child’s hands the same sensation of a collapsing pulse of aortic regurgitation [Lecture 60 in 1837; published 1842: 647)]

The pulse of aortic regurgitation is sometimes at least very striking and peculiar: sudden like the blow of a hammer without any prolonged swell of an artery. It always reminds me of the well-known chemical toy, formed by including a small quantity of liquid in a glass tube exhausted of air and hermetically sealed. On reversing the tube the liquid falls from one end of it to the other with a hard, short knock, as if it were a mass of lead. The sensation given by the pulse, when there is much regurgitation through the aortic valves, is very similar to this.

Watson 1842

Associated Persons

• Raymound Vieussens (1641 – 1715)
• Thomas Hodgkin (1798 – 1866)
• Sir Dominic John Corrigan (1802 – 1880)
• Sir Thomas Watson (1792 – 1882)

Alternative names

• Water Hammer pulse (often incorrectly used)
• Corrigan’s pulse
• Pulse of Vieussens

Controversies

The original descriptions of aortic regurgitation and the characteristic pulse signs associated with the disease have been widely debated. However, while the observation of visible arterial pulsations in aortic incompetence had been described prior to Sir Corrigan, he was argued to be the first to present a comprehensive overview of the disease.

References

Original articles

• Vieussens R. Novum vasorum corporis humani systema. Amstelodami: apud Paulum Marret….1705.
• Vieussens R et al. Traité nouveau de la structure et des causes du mouvement naturel du coeur. Premier edition. A Toulousse: chez Jean Guillemette, imprimeur & librarie ….1715.
• Cuming T. A Case of Diseased Heart, with Observations. Dublin Hospital Reports. 1822; 3: 319–334. [Early description Corrigan pulse]
• Hodgkin T. On retroversion of the valves of the aorta. London Medical Gazette 1829; 3: 433-43. [Early description Corrigan pulse]
• Corrigan DJ. On permanent patency of the mouth of the aorta, or inadequacy of the aortic valves. The Edinburgh Medical and Surgical Journal, 1832; 37: 225-245.

Eponymous term reviews

• Trousseau A. Revue bibliographique. Gazette des hôpitaux civils et militaires. 1839; 117(1:II): 465-466 [Introduced the term Maladie de Corrigan for aortic regurgitation]
• Watson T. Diseases of the heart. Lecture 60 on the principles and practice of physic. London Medical Gazette. 1842 Jan 21; 29: 641–650 [Watson water-hammer pulse p647]
• Dock GI. Dominic John Corrigan: his place in the development of our knowledge of cardiac disease. II. The water-hammer pulse. Annals of Medical History. 1934; III (VI): 381–395.
• Sir Dominic John Corrigan. Medical Classics. 1937; 1(6): 672-727.
• Adams CW. Aortic insufficiency: “Original” descriptions. The American Journal of Cardiology. 1969; 24(5): 731-33.
• Mulcahy R. The early descriptions of aortic incompetence. Br Heart J. 1962 ;24(5): 633-6.
• Zhang G. Eponyms in Aortic Regurgitation. LITFL 2019

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