Quincke’s Pulse

Pulsation of nail beds.
Card Tutorial

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’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.