IMAGES IN CLINICAL MEDICINE

Corrigan’s Pulse and Quincke’s Pulse

Hector I. Michelena, and Maurice Enriquez-Sarano

N Engl J Med 2018; 379:e9

DOI: 10.1056/NEJMicm1715353

A 58-year-old man was referred to the cardiology clinic for evaluation of exertional dyspnea. Twelve years before presentation, he had undergone a bioprosthetic aortic-valve replacement for treatment of severe bicuspid aortic stenosis and for repair of an ascending aortic aneurysm. On physical examination, his blood pressure was 142/57 mm Hg. Auscultation revealed systolic and diastolic murmurs that had a prominent holodiastolic component. While the patient was sitting upright, the right carotid artery was visibly pulsatile, with systolic swelling and rapid diastolic collapse — a sign known as Corrigan’s pulse (Panel A, arrow, and Video 1). The tips of the patient’s index finger and thumb as well as the nail bed of the thumb exhibited capillary pulsation — a sign known as Quincke’s pulse (Panel B, arrow, and Video 2). Corrigan’s pulse and Quincke’s pulse are two findings of chronic severe aortic regurgitation and are manifestations of a wide pulse pressure with large systolic stroke volume and rapid fall in arterial pressure. Echocardiography revealed a left ventricular ejection fraction of 56%, an end-systolic diameter of 46 mm (an increase from 36 mm measured in the previous year), and severe regurgitation of the prosthetic aortic valve. Because of progressive left ventricular dilatation and exertional dyspnea, the patient underwent valve-in-valve transcatheter aortic-valve replacement. The patient’s dyspnea resolved after the procedure, and he is currently doing well.

一名58岁男性患者因劳累后呼吸困难到心脏内科门诊就诊。发病前12年，患者曾因主动脉瓣重度狭窄接受主动脉瓣置换（生物瓣膜）及升主动脉瘤修补术。体格检查发现，患者血压142/57 mmHg。听诊可闻及收缩期及全舒张期杂音。患者直立坐位时，可见右侧颈动脉搏动，收缩期充盈，舒张期快速塌陷—这称为Corrigan脉（图A箭头所示，及视频1）。患者食指及拇指指尖以及拇指甲床均可见毛细血管搏动—这一体征称为Quincke脉（图B箭头所示，及视频2）。Corrigan脉及Quincke脉是慢性主动脉瓣重度返流时的表现，表明脉压差很大，每搏输出量很大，动脉压迅速下降。心脏超声检查发现左室射血分数56%，收缩末直径46 mm（前一年测定结果为36 mm），主动脉瓣人工瓣膜重度返流。由于左室进行性扩大，劳累后呼吸困难进行性加重，患者接受了经导管主动脉瓣置换术。术后患者呼吸困难缓解，目前一般情况良好。