True about Pulsus bisferiens:
Ans. b (Double peak, both in systole). (Ref. Harrison Medicine /16th ed., 1305 & 1416).ARTERIAL PULSESVARIOUS ARTERIAL PULSESMECHANISMETIOLOGYPulsus paradoxusDecrease in SBP (< 10 mm Hg) that normally accompanies decrease in arterial pulse amplitude during inspiration.It refers to a fall in systolic pressure >10 mmHg with inspiration.Airway obstruction accentuated# Pericardial effusion# Pericardial temponadeQ# Pulmonary embolism (massive)# SVC obstruction# Hemorrhagic shock# Severe obstructive lung disease# Tension pneumothorax.Pulsus bigeminusRegular alteration of pressure pulse amplitude, but it is caused by a premature ventricular contraction that follows each regular beat.PVCsPulsus alternansRegular alteration of pressure pulse amplitude, despite regular rhythm.(defined by beat-to-beat variability of pulse amplitude. And is present only when every other phase 1 Korotkoff sound is audible as the cuff pressure is lowered slowly, typically in a patient with a regular heart rhythm and independent of the respiratory cycle)# LVF/severe left ventricular systolic heart failure# PAT after premature beatsPulsus bisferiens OR Bifid pulse (percussion & tidal wave)Two systolic peaks (MH 2006).A bifid pulse is easily appreciated in patients on intra-aortic balloon counterpulsation (IABP), in whom the second pulse is diastolic in timing.Advanced AR/HOCM (A bifid pulse described in patients with HOCM, with inscription of percussion and tidal waves)Dicrotic pulse2 palpable waves, 1 in systole 1 in diastoleDCMPulsus parvus (hypokinetic)Small weak pulseA weak and delayed pulse (pulsus parvus et tardus) defines severe aortic stenosis (AS).# LVF,# MS,# Restrictive pericardial diseasePulsus tardusDelayed systolic peak# ASHyperkinetic # CHB,# Anemia,# Fever,# Exercise,# HyperthyroidismAnacrotic pulseA slow, notched, or interrupted upstroke (with a thrill or shudder).Some patients with ASCorrigan's or water- hammer pulse)The carotid upstroke has a sharp rise and rapid fall-off.Chronic severe ARBounding pulse # VSD,# Chronic AR# Ruptured sinus of Valsalva# MR,# HypertensionNote: The character of the pulse is best appreciated at the carotid level.
Double peak, one is systole and another in diastole
Double peak, both in systole
Seen in patients with dilated cardiomyopathy
Seen only when aortic stenosis is associated with aortic regurgitation
C.V.S.