{"id":5872,"date":"2020-06-15T14:06:14","date_gmt":"2020-06-15T21:06:14","guid":{"rendered":"https:\/\/up.physicaldiagnosispdx.com\/up\/?page_id=5872"},"modified":"2021-05-03T16:41:23","modified_gmt":"2021-05-03T23:41:23","slug":"quinckes-pulse","status":"publish","type":"page","link":"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-multimedia-new\/quinckes-pulse\/","title":{"rendered":"Quincke&#8217;s Pulse"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[vc_row css=&#8221;.vc_custom_1592155698727{background-color: #fff9f9 !important;}&#8221;][vc_column][vc_column_text]<span style=\"font-size: 14pt;\">Pulsation of nail beds.<\/span><br \/>\n<figure id=\"attachment_1658\" aria-describedby=\"caption-attachment-1658\" style=\"width: 150px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-2\/card-tutorial\/#Aortic_Regurgitation\"><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-1658 size-thumbnail\" src=\"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308-150x150.png\" alt=\"\" width=\"150\" height=\"150\" srcset=\"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308-150x150.png 150w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308-300x300.png 300w, https:\/\/up.physicaldiagnosispdx.com\/up\/wp-content\/uploads\/iconfinder_3_1250308.png 512w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a><figcaption id=\"caption-attachment-1658\" class=\"wp-caption-text\">&nbsp;<\/figcaption><\/figure>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 1:<\/h1>\n<p><span style=\"font-size: 14pt;\">This is an older man with moderate alcohol use who developed the clinical syndrome of heart failure. Echocardiography was unremarkable. He was noted to have a wide pulse pressure and Quincke&#8217;s pulse on exam, which led to the hypothesis of high output heart failure. Right heart catheterization confirmed the diagnosis, demonstrating a cardiac output of 12 L\/min. Thiamine levels were severely low, consistent with the diagnosis of wet beriberi. With abstinence from alcohol and thiamine replacement therapy, the patient completely recovered without the need for diuretic therapy. Pulse pressure narrowed back to normal.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472331617?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&amp;lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&amp;gt;\ufeff&amp;lt;\/span&amp;gt;<\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 2:<\/h1>\n<p><span style=\"font-size: 14pt;\">This is a young man with a history of a congenital quadricuspid aortic valve and 16 years earlier had undergone a Ross procedure<\/span><br \/>\n<span style=\"font-size: 14pt;\">(during which the aortic valve was replaced by a pulmonary autograft and the pulmonary valve was replaced by a pulmonary homograft), who developed endocarditis of the pulmonary autograft.<\/span><\/p>\n<p><a href=\"https:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMicm1215624\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-size: 14pt;\">Video courtesy of NEJM: &#8220;Quincke&#8217;s Pulse&#8221;<\/span><\/a>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472330936?loop=1\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&gt;\ufeff&lt;\/span&gt;<\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1 id=\"patient3\">Patient 3:<\/h1>\n<p><span style=\"font-size: 14pt;\">This is a middle-aged woman with end-stage renal disease who receives dialysis through a brachial arteriovenous fistula. <\/span><\/p>\n<p><span style=\"font-size: 14pt;\">This patient also has a <a href=\"https:\/\/up.physicaldiagnosispdx.com\/up\/nephrology\/nephrology-m\/arteriovenous-fistula\/#patient1\" target=\"_blank\" rel=\"noopener noreferrer\">continuous bruit over the fistula.<\/a><\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472331149?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&gt;\ufeff&lt;\/span&gt;<\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 4:<\/h1>\n<p><span style=\"font-size: 14pt;\">This patient has severe aortic regurgitation.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472344243?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&gt;\ufeff&lt;\/span&gt;<\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 5:<\/h1>\n<p><span style=\"font-size: 14pt;\">This patient has severe aortic regurgitation.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472331928?loop=1\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&gt;\ufeff&lt;\/span&gt;<\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 6:<\/h1>\n<p><span style=\"font-size: 14pt;\">This patient has Quincke&#8217;s pulse related to the high output state of sepsis.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472332043?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&gt;\ufeff&lt;\/span&gt;<\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 7:<\/h1>\n<p><span style=\"font-size: 14pt;\">This patient has severe aortic regurgitation.<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/472331089?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">&lt;span data-mce-type=&#8221;bookmark&#8221; style=&#8221;display: inline-block; width: 0px; overflow: hidden; line-height: 0;&#8221; class=&#8221;mce_SELRES_start&#8221;&gt;\ufeff&lt;\/span&gt;<\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1 id=\"patient8\">Patient 8:<\/h1>\n<p><span style=\"font-size: 14pt;\">This is a middle-age man who was admitted to the hospital with cardiogenic shock of unclear etiology. He was discovered to have Corrigan&#8217;s pulse on exam, which led to the discovery of Quincke&#8217;s pulse, radial-femoral pulse delay, and discrepent blood pressures between the upper and lower extremities. He was subsequently diagnosed with coarctation of the aorta. <\/span><\/p>\n<p><span style=\"font-size: 14pt;\">This patient also has <a href=\"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-multimedia-new\/corrigans-pulse\/#patient3\">Corrigan&#8217;s pulse<\/a>, <a href=\"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-multimedia-new\/vigorous-peripheral-pulse\/#patient2\">vigorous peripheral pulses in the upper extremities<\/a>, <a href=\"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-multimedia-new\/radial-femoral-pulse-delay\/#patient1\">radial-femoral pulse delay<\/a>, and a <a href=\"https:\/\/up.physicaldiagnosispdx.com\/up\/cardiology-multimedia-new\/aortic-coarctation\/#patient1\">systolic murmur.<\/a><\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592155788700{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/507687031?loop=1\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1 id=\"patient9\">Patient 9:<\/h1>\n<p><span style=\"font-size: 14pt;\">This is an older woman with NASH cirrhosis who was admitted to the hospital with hepatic encephalopathy. She was noted to have a wide pulse pressure and Quincke&#8217;s pulse on examination. There was no clinical evidence of heart failure, so this likely represents simple high-output physiology (not high-output heart failure).<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592017173859{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/542407899?loop=1\" width=\"320\" height=\"650\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><span style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" data-mce-type=\"bookmark\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\n<h1>Patient 10:<\/h1>\n<p><span style=\"font-size: 14pt;\">Older man with underlying cirrhosis and obesity who presents with the clinical syndrome of heart failure (exertional dyspnea, orthopnea, elevated JVP) and is found to have wide pulse pressure and Quincke&#8217;s pulse, raising the possibility of high-ouput heart failure.<\/span><\/p>\n<p>&nbsp;[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1592017173859{background-color: #dcd9dd !important;}&#8221;][vc_column][vc_column_text]\n<p style=\"text-align: center;\"><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/543308421?loop=1\" width=\"320\" height=\"550\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" data-mce-type=\"bookmark\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n[\/vc_column_text][\/vc_column][\/vc_row]\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row css=&#8221;.vc_custom_1592155698727{background-color: #fff9f9 !important;}&#8221;][vc_column][vc_column_text]Pulsation of nail beds. [\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text] Patient 1: This is an older man with moderate alcohol use who developed the clinical syndrome of heart failure. Echocardiography was unremarkable. He was noted to have a wide pulse pressure and Quincke&#8217;s pulse on exam, which led to the hypothesis of<\/p>\n","protected":false},"author":9,"featured_media":0,"parent":3164,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"page-templates\/page_PDXPDX-full-width.php","meta":{"nf_dc_page":"","_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"class_list":["post-5872","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/5872","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/comments?post=5872"}],"version-history":[{"count":18,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/5872\/revisions"}],"predecessor-version":[{"id":10567,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/5872\/revisions\/10567"}],"up":[{"embeddable":true,"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/pages\/3164"}],"wp:attachment":[{"href":"https:\/\/up.physicaldiagnosispdx.com\/up\/wp-json\/wp\/v2\/media?parent=5872"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}