How do you detect pulsus bisferiens?
Pulsus bisferiens can be more pronounced by the Valsalva maneuver. On palpation of a peripheral pulse (radial artery), two upstrokes distinguished by a mid-systolic gap in the systole are characteristic of pulsus bisferiens. Jugular venous pressure (JVP) examination may reveal classical ‘a’ wave in HOCM.
What type of pulse is seen in aortic regurgitation?
The water hammer pulse is a physical exam finding with many different etiologies. However, it is commonly associated with aortic regurgitation. It will feel like a tapping impulse through the patient’s forearm due to the rapid emptying of blood from the arm during diastole.
What is upstroke in pulse?
The normal carotid upstroke is brisk, with a rapid rise leading to the pressure peak, and then falls rapidly in the latter part of systole. In contrast, a hyperkinetic pulse is characterized by a more rapid upstroke and similarly a more rapid downstroke than normal.
When do you see Pulsus alternans?
Pulsus alternans (during pulse palpation, this is the alternation of one strong and one weak beat without a change in the cycle length) occurs most commonly in heart failure due to increased resistance to LV ejection, as occurs in hypertension, aortic stenosis, coronary atherosclerosis, and dilated cardiomyopathy.
What does Hocm stand for?
This type of hypertrophic cardiomyopathy may be called hypertrophic obstructive cardiomyopathy (HOCM). HCM also may cause thickening in other parts of the heart muscle, such as the bottom of the heart called the apex, right ventricle, or throughout the entire left ventricle.
Why does aortic regurgitation cause Pulsus Bisferiens?
The bisferiens pulse in severe aortic regurgitation has been attributed to a Venturi effect that occurs in the ascending aorta in mid-systole due to the high flow produced by ventricular ejection.
How do you know if you have aortic regurgitation?
Even if you don’t have symptoms, your doctor may be able to detect aortic regurgitation by listening to your heart with a stethoscope. If your doctor hears a whooshing sound in between beats, it could mean you have valve problems. The whooshing sound means there is an abnormal flow of blood through the valve.
What is the strongest pulse in the body?
The carotid artery
The carotid artery is the strongest pulse because it is in an artery that is relatively large, close to the skin’s surface and relatively close to the…
What does pulsus alternans suggest?
Pulsus alternans indicate cardiac pathology, particularly left ventricular dysfunction and is considered a poor prognostic indicator. When identified, pulsus alternans should elicit prompt treatment of the underlying causative process.
What does electrical alternans indicate?
Electrical alternans. This electrocardiogram shows ventricular tachycardia from the right ventricular outflow tract (RVOT) region. Note the R wave alternans seen in the wide QRS complexes. The presence of micro-T wave alternans may indicate a higher risk of sudden cardiac death and spontaneous ventricular arrhythmias.
What does pulsus bisferiens mean in medical terms?
Pulsus bisferiens. Pulsus bisferiens, also known as biphasic pulse, is an aortic waveform with two peaks per cardiac cycle, a small one followed by a strong and broad one. It is a sign of problems with the aorta, including aortic stenosis and aortic regurgitation, as well as hypertrophic cardiomyopathy causing subaortic stenosis.
What kind of wave pattern is a pulsus bisferiens?
Pulsus bisferiens or double pulse refers to a wave pattern where there is the presence of two systolic peaks that can be seen in pressure tracings of the the ascending aorta, the aortic arch, and the carotid artery.
Can a Valsalva maneuver cause pulsus bisferiens?
The Valsalva maneuver or inhalation of amyl nitrate can precipitate pulsus bisferiens in some cases. Pulsus bisferiens can also be seen in hypertrophic obstructive cardiomyopathy (HOCM), patent ductus arteriosus, arteriovenous fistulas and normal hearts in a hyperdynamic state.
How is pulsus bisferiens related to the mitral valve?
Pulsus bisferiens is due to systolic anterior motion (SAM) of the mitral valve. Because the mitral valve leaflet doesn’t get pulled into the left ventricular outflow tract (LVOT) until after the aortic valve opens, the initial upstroke of the arterial pulse pressure will be normal.