water hammer pulse

コリガン脈拍

WordNet

1. provide with water; "We watered the buffalo"
2. binary compound that occurs at room temperature as a clear colorless odorless tasteless liquid; freezes into ice below 0 degrees centigrade and boils above 100 degrees centigrade; widely used as a solvent (同)H2O
3. supply with water, as with channels or ditches or streams; "Water the fields" (同)irrigate
4. once thought to be one of four elements composing the universe (Empedocles)
5. secrete or form water, as tears or saliva; "My mouth watered at the prospect of a good dinner"; "His eyes watered"
6. a liquid necessary for the life of most animals and plants; "he asked for a drink of water"
7. fill with tears; "His eyes were watering"
8. beat with or as if with a hammer; "hammer the metal flat"
9. the part of a gunlock that strikes the percussion cap when the trigger is pulled (同)cock
10. the act of pounding (delivering repeated heavy blows); "the sudden hammer of fists caught him off guard"; "the pounding of feet on the hallway" (同)pound, hammering, pounding
11. a power tool for drilling rocks (同)power hammer
12. a hand tool with a heavy rigid head and a handle; used to deliver an impulsive force by striking
13. a heavy metal sphere attached to a flexible wire; used in the hammer throw
14. a striker that is covered in felt and that causes the piano strings to vibrate
15. drive by or as if by pulsation; "A soft breeze pulsed the air"
16. the rate at which the heart beats; usually measured to obtain a quick evaluation of a persons health (同)pulse_rate, heart_rate
17. the rhythmic contraction and expansion of the arteries with each beat of the heart; "he could feel the beat of her heart" (同)pulsation, heartbeat, beat
18. edible seeds of various pod-bearing plants (peas or beans or lentils etc.)
19. produce or modulate (as electromagnetic waves) in the form of short bursts or pulses or cause an apparatus to produce pulses; "pulse waves"; "a transmitter pulsed by an electronic tube" (同)pulsate
20. wetting with water; "the lawn needs a great deal of watering"
21. shaped or worked with a hammer and often showing hammer marks; "a bowl of hammered brass"

PrepTutorEJDIC

1. 〈U〉水 / 《しばしば複数形で》『海』(『湖,川』)『の水』 / 《複数形で》流れる水;(海・川・湖などの)波立つ水《+of+名》 / 《複数形で》(特定の)水域,領海,近海 / 〈U〉潮位,水位;《the water》水面 / 〈U〉分泌液(涙・汗・尿など) / 〈U〉溶液,…水 / 《複数形で》(飲用の)鉱泉水 / 〈U〉(織物・金属などの)波紋 / …‘に'『水をかける』(まく,やる) / 〈動物〉‘に'水を飲ませる / …‘に'水を供給する;…‘を'潅漑(かんがい)する / 〈液体など〉‘を'水で割る,薄める《+名+down,+down+名》 / 〈織物・金属など〉‘に'波紋(波模様)をつける / 〈動物などが〉水を飲む:〈船・機関などが〉給水を受ける / 〈目・口などが〉分泌液を出す
2. 『金づち』,ハンマー / ハンマーに似た物,(銃の)撃鉄,(ピアノの弦を打つフェルトの)つち,(競売人の)木づち,(ベる・ゴングなどの)打ち子 / (ハンマー投げの)ハンマー / (耳の中の)槌骨(ついこつ) / (金づち・こぶしなどで)…‘を'『こつこつとたたく』(『打つ』)《+『名』+『with』+『名』》 / …‘を'つちでたたいて作る《+『名』+『out,』+『out』+『名』》 / (人の頭に)〈考え・事柄など〉‘を'繰り返して教え込む《+『名』+『into』(『in』)+『名』》 / 《話》〈相手〉‘を'打ち負かす,やっつける / (…を)金づちで打つ;(つえやこぶしなどで)(…を)ドンドンとたたく《+『at』(『on』)+『名』》
3. 《通例単数形で》『脈はく』 / (一般に,規則的な)鼓動,律動 / (電気の)パルス / (一般的な)傾向 / 脈を打つ,鼓動する
4. 〈U〉《時に複数扱い》(食用の)豆類 / 〈C〉《通例複数形で》豆のとれる植物

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/02/24 23:19:59」(JST)

wiki en

[Wiki en表示]

Watson's water hammer pulse is the medical sign which describes a pulse that is bounding and forceful, rapidly increasing and subsequently collapsing, as if it were the hitting of a water hammer that was causing the pulse.

This is associated with increased stroke volume of the left ventricle and decrease in the peripheral resistance leading to the widened pulse pressure of aortic regurgitation.

Eponym

"Watson's water hammer pulse" and "Corrigan's pulse" refer to similar observations. However, the former usually refers to measurement of a pulse on a limb, while the latter refers to measurement of the pulse of the carotid artery.

• "Corrigan's pulse" is named for Sir Dominic Corrigan, the Irish physician, who characterized it in 1832.

• "Watson's water hammer pulse" is named for Thomas Watson, who characterized it in 1844.

Observation

To feel a water hammer pulse: with the patient reclining, the examiner raises the patient's arm vertically upwards. The examiner grasps the muscular part of the patient's forearm. A water hammer pulse is felt as a tapping impulse which is transmitted through the bulk of the muscles. This happens because the blood that is pumped to the arm during systole is emptied very quickly due to the gravity effect on the raised arm. This results in the artery emptying back into the heart during diastole, therefore causing a palpable pulse.

Causes

Water hammer pulse is commonly found when a patient has in aortic regurgitation. A more comprehensive list of causes follows:

1. Physiological

• Fever
• Pregnancy

2. Cardiac lesions

• Aortic regurgitation
• Patent ductus arteriosus
• Systolic hypertension
• Bradycardia
• Aortopulmonary window
• Rupture of sinus of Valsalva into heart chambers

3. Syndromes or High output states

• Anemia
• Cor pulmonale
• Cirrhosis of liver
• Beriberi
• Thyrotoxicosis
• Arteriovenous fistula
• Paget's disease

4. Other causes

• Chronic alcoholism

See also

• Blood hammer

References

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 動脈拍動の検討 examination of the arterial pulse
• 2. 成人における慢性大動脈弁閉鎖不全症の病態生理、臨床的特徴、および評価 pathophysiology clinical features and evaluation of chronic aortic regurgitation in adults
• 3. 成人における急性大動脈弁閉鎖不全症 acute aortic regurgitation in adults
• 4. 小児における大動脈弁閉鎖不全 aortic regurgitation in children
• 5. 僧帽弁または大動脈弁閉鎖不全症の患者の非心臓手術 noncardiac surgery in patients with mitral or aortic regurgitation

English Journal

• Validation of finite element computations for the quantitative prediction of underwater noise from impact pile driving.

• Zampolli M, Nijhof MJ, de Jong CA, Ainslie MA, Jansen EH, Quesson BA.SourceTNO, Acoustics and Sonar Group, P.O. Box 96864, 2509 JG, The Hague, The Netherlands. mario.zampolli@ctbto.org
• The Journal of the Acoustical Society of America.J Acoust Soc Am.2013 Jan;133(1):72-81. doi: 10.1121/1.4768886.
• The acoustic radiation from a pile being driven into the sediment by a sequence of hammer strikes is studied with a linear, axisymmetric, structural acoustic frequency domain finite element model. Each hammer strike results in an impulsive sound that is emitted from the pile and then propagated in t
• PMID 23297884

• Dynamics of sonoluminescing bubbles within a liquid hammer device.

• Urteaga R, García-Martínez PL, Bonetto FJ.SourceLaboratorio de Cavitación y Biotecnología 8400, Instituto Balseiro/Centro Atómico Bariloche, RN, Argentina.
• Physical review. E, Statistical, nonlinear, and soft matter physics.Phys Rev E Stat Nonlin Soft Matter Phys.2009 Jan;79(1 Pt 2):016306. Epub 2009 Jan 14.
• We studied the dynamics of a single sonoluminescing bubble (SBSL) in a liquid hammer device. In particular, we investigated the phosphoric acid-xenon system, in which pulses up to four orders of magnitude brighter than SBSL in water systems (about 10;{12} photons per pulse) have been previously repo
• PMID 19257138

• Myocardial steatosis is an independent predictor of diastolic dysfunction in type 2 diabetes mellitus.

• Rijzewijk LJ, van der Meer RW, Smit JW, Diamant M, Bax JJ, Hammer S, Romijn JA, de Roos A, Lamb HJ.SourceDepartment of Endocrinology, VU University Medical Center, Amsterdam, the Netherlands.
• Journal of the American College of Cardiology.J Am Coll Cardiol.2008 Nov 25;52(22):1793-9. doi: 10.1016/j.jacc.2008.07.062.
• OBJECTIVES: The purpose of this study was to compare myocardial triglyceride content and function between patients with uncomplicated type 2 diabetes mellitus (T2DM) and healthy subjects within the same range of age and body mass index (BMI), and to study the associations between myocardial triglyce
• PMID 19022158

Japanese Journal

• Water-hammer formula に基づく上行大動脈局所脈波速度計測の妥当性の研究 : 2点計測法との対比における検討

• 半谷 静雄
• 脈管学 : 日本脈管学会機関誌 : the journal of Japanese College of Angiology 51(2), 215-221, 2011-06-25
• NAID 10029415283

• レーザーアブレーションを用いたインパルス加振に基づく振動実験解析法(機械力学,計測,自動制御)

• 細矢 直基,梶原 逸朗,反町 仁
• 日本機械学會論文集. C編 75(760), 3160-3167, 2009-12-25
• … In conventional vibration testing using an impulse hammer, high frequency elements of over tens of kilohertz are barely present in the excitation force. … A high-power YAG pulse laser is used in this system for producing an ideal impulse force on a structural surface. … Additionally, a water droplet overlay on the metal is used to adjust the force magnitude of laser excitation. …
• NAID 110007503912

• 203 レーザー加振技術を用いた高周波振動計測に基づくヘルスモニタリング(セッション5 スマート構造システム(1))

• 梶原 逸朗,細矢 直基
• 評価・診断に関するシンポジウム講演論文集 2009(8), 90-95, 2009-12-08
• … In conventional vibration testing using an impulse hammer, the excitation force hardly includes high frequency element over tens of kilohertz. … High power YAG pulse laser is used in this system for producing an ideal impulse force on structural surface. … And water droplet overlay on the metal is used to adjust the force magnitude in laser excitation. …
• NAID 110008009912

Related Links

• Watson's water hammer pulse - Wikipedia, the free encyclopedia

Watson's water hammer pulse is the medical sign which describes a pulse that is bounding and forceful, rapidly increasing and subsequently collapsing, as if it were the hitting of a water hammer that was causing the pulse. This is associated ...

• Watson's water hammer pulse Suvarna JC - J Postgrad Med

Watson's water hammer pulse (whp), also known as collapsing pulse, cannonball pulse or pulsus celer, is used to describe ... The water hammer pulse is felt as an impact (tapping pulse) through the bulk of the forearm muscles with the thenar ...

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★リンクテーブル★

リンク元	「大動脈弁閉鎖不全症」「コリガン脈」
関連記事	「hammer」「water」「watering」「pulse」

「大動脈弁閉鎖不全症」

　　[★]

日本では、英語表記ではaortic regurgitation AR、日本語表記では「大動脈弁閉鎖不全症」とするのが一般的？

同

大動脈弁閉鎖不全症 大動脈弁閉鎖不全 aortic valve insufficiency, AI

同

大動脈弁逆流症 大動脈弁逆流 aortic regurgitation AR, aortic valve regurgitation

関

弁膜症

[show details]

ja

大動脈弁閉鎖不全症 : 約 28,700 件
大動脈弁閉鎖不全 : 約 41,400 件
大動脈弁逆流症 : 約 18,300 件
大動脈弁逆流 : 約 6,780 件

aortic valve insufficiency : 56 件
aortic insufficiency : 約 643 件
aortic valve regurgitation : 約 419 件
aortic regurgitation : 約 1,830 件

en

aortic valve insufficiency : 約 125,000 件
aortic insufficiency : 約 89,400 件
aortic valve regurgitation : 約 125,000 件
aortic regurgitation : 約 183,000 件

概念

• 大動脈弁の閉鎖不全により、拡張期に大動脈の血液が左心室に逆流する病態。
• 左室の容量負荷が特徴

身体所見

聴診

• 心音：S1↑, S2？, S3？,S4？

参考6

• S1：soft
• S2：variable
• A2：soft～absent
• P2：normal
• S3：左心機能が落ちれば聴取される

• 心雑音

• 拡張期逆流性雑音 = 拡張期灌水様雑音 = blowing murmur in early diastole along the left sternal border

最強点：3LSB。

持続時間：軽症・急性型では持続時間は短い。

音量は一定かだんだん小さくなる(decrescendo)

重症度と音量は相関しないが、雑音の持続時間は参考になる。軽症では拡張期の初期にのみ吹くような(blowing)音が聴取される。重症になるにつれだんだん伸びていき、しまいには拡張期全体に聴取されるようになり、音は粗な音である(rougher)。

(参考6) :::持続時間は重症度を反映しないが、軽度ARでは持続時間は短い(なぜ?)。また急性ARでも短いが、これは拡張期にすぐに大動脈と左心室の圧が均衡するからである(圧較差が小さいということか？)。(up2date)

• Austin Flint murmur：拡張期中期に低音を心尖で聴取。拡張期に大動脈弁から逆流してくる血液の乱流により、僧帽弁前尖が下方に押し下げられMS様の雑音を生じる。Austin Flint雑音はMSと違ってopening snapがなく、収縮期前期の雑音の増強がない。(PHD.214)

特徴的な身体所見 PHD.215

二峰性脈	bisferiens pulse	頚動脈や腕頭動脈で収縮期に二峰性の脈を感じる
コリガン脈	Corrigan pulse	著しく膨張し虚脱する脈
ミュッセ徴候	de Musset sign	収縮期に頭が上下に動く
デュロジェ雑音	Duroziez sign	大腿動脈を軽く押さえると往復雑音が聴取される
ヒル徴候	Hill sign	収縮期の膝窩動脈圧が上腕動脈圧よりも60mmHg高い
ミュラー徴候	Muller sign	uvulaの収縮期のは駆動
クインケ徴候	Quincke sign	口唇や近位爪床で毛細血管の拍動が見える
トラウベ徴候	Traube sign	Pistol-shot音が大腿動脈で聴取される

末梢の症状にトラウベ徴候、デュロジェ雑音、コリガン脈(water hammer pulse)があるが、これらは慢性ARでは特徴的だが、急性ARではほとんど見られない。急性ARではstroke volume and diastolic filling volumeが増えないためである(uptodate)

検査

心エコー

• 拡張期僧帽弁前尖のfluttering　→　大動脈弁からの逆流により僧帽弁前尖が狭窄し機能的に僧帽弁狭窄症　→　オースチン・フリント雑音

治療

外科治療

• 重症ARでありかつ症状がある場合　→　手術推奨
• 重症ARでありかつ症状が無い場合

• 左室機能低下(LVEF<50%)している場合　→　手術推奨
• 左室機能正常の場合

• 収縮終期左室径 LVESd＞45mm の場合　→　手術推奨
• 収縮終期左室径 LVESd≦45mm の場合

• 拡張終期左室径 LVEDd＞65mm の場合　→　手術推奨
• 拡張終期左室径 LVEDd≦65mm の場合

• 収縮終期左室径指数 ＞25mm/m^2 の場合 →　手術推奨

内科治療

• 非手術適応

• 重症AR

• 目標：降圧(sBP<140mmHg)
• CCB, ACE-I/ARB
• β blockerは一回拍出量の増加に繋がり、sBPを上昇させうるのて好ましくない。

• 中等症AR

• 内科的治療による予後改善効果におけるデータはない

• 手術適応

• 重症AR

• ACE-I/ARB

参考

• 1. mayoclinic

http://www.mayoclinic.com/health/aortic-valve-regurgitation/ds00419

• 2. virtualmedicalcentre

http://www.virtualmedicalcentre.com/diseases.asp?did=7

• 3. heart-valve-surgery

http://www.heart-valve-surgery.com/aortic-valve-regurgitation-symptoms.php

• 4. AHA americanheart

http://www.americanheart.org/presenter.jhtml?identifier=4448

• 5. patient.co.uk

http://www.patient.co.uk/health/Aortic-Regurgitation.htm

• 6. [charged] Pathophysiology and clinical features of chronic aortic regurgitation in adults - uptodate [1]

ガイドライン

• 1. 弁膜疾患の非薬物治療に関するガイドライン（2007年改訂版）

http://www.j-circ.or.jp/guideline/pdf/JCS2007_matsuda_h.pdf

• 2. 2020 年改訂版弁膜症治療のガイドライン

https://www.j-circ.or.jp/old/guideline/pdf/JCS2020_Izumi_Eishi.pdf

国試

• 103D059

「コリガン脈」

　　[★]

英

Corrigan pulse Corrigan's pulse

同

コリガン脈拍、Corrigan脈、水槌脈 ウォーター・ハンマー脈拍 ウォーターハンマー脈 water hammer pulse、虚脱脈 collapsing pulse

関

大動脈弁閉鎖不全症

• 速脈の一種

• 大動脈弁閉鎖不全症にみられる迅速かつ強大な脈拍

「hammer」

　　[★] ツチ骨 　 　 　 　 　 　 　 　

「water」

　　[★]

• n.

• 水

　 　 　 　 　 　 　 　

「watering」

　　[★]

• n.

• 灌水

関

suffusion

　

「pulse」

　　[★] 脈拍