Dicrotic pulse differs from pulse bisferiens in
Ans. c (Characterized by two palpable weak waves, one in systole and other in diastole) (Ref. Harrison, Principles of Medicine - 18th/Chapter 227)The bisferiens pulse, which has two systolic peaks, is characteristic of aortic regurgitation (with or without accompanying stenosis) and of hypertrophic cardiomyopathy. In the latter condition, the pulse wave upstroke rises rapidly and forcefully, producing the first systolic peak ("percussion wave"). A brief decline in pressure follows because of the sudden midsystolic decrease in the rate of left ventricular ejection, when severe obstruction often develops. This pressure trough is followed by a smaller and more slowly rising positive pulse wave ("tidal wave") produced by continued ventricular ejection and by reflected waves from the periphery. The dicrotic pulse has two palpable waves, one in systole and one in diastole. It usually denotes a very low stroke volume, particularly in patients with dilated cardiomyopathy.# Pulsus alternans (pulses normalis aggregans) is a pattern in which there is regular alteration of the pressure pulse amplitude, despite a regular rhythm. It is due to alternating left ventricular contractile force, usually indicates severe impairment of left ventricular function, and commonly occurs in patients who also have a loud third heart sound. Pulsus alternans may also occur during or following paroxysmal tachycardia or for several beats following a premature beat in patients without heart disease.# In pulsus bigeminus, there is also a regular alteration of pressure pulse amplitude, but it is caused by a premature ventricular contraction that follows each regular beat.# In pulsus paradoxus, the decrease in systolic arterial pressure that normally accompanies the reduction in arterial pulse amplitude during inspiration is accentuated. In patients with pericardial tamponade, airway obstruction, or superior vena cava obstruction, the decrease in systolic arterial pressure frequently exceeds the normal decrease of 10 mm Hg and the peripheral pulse may disappear completely during inspiration.ARTERIAL PULSESVARIOUS ARTERIAL PULSESMECHANISMETIOLOGYPulsus paradoxusDecrease in SBP (< 10 mm Hg) that normally accompanies decrease in arterial pulse amplitude during inspiration is accentuated.It refers to a fall in systolic pressure >10 mmHg with inspiration.# Pericardial effusion# Pericardial temponade# 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 in scription 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,# HypertensionAlso remember:
Seen in HOCM
Indicates high stroke output
Characterized by two palpable weak waves, one in systole and other in diastole
Characterized by 2 palpable weak waves, both in systole
C.V.S.