Pulsus bisferiens || #USMLE || #Cardiology
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PULSUS BISFERIENS
The normal carotid arterial pulse tracing and the central aortic pulse waveform consist of an early component, the percussion wave, which results from rapid left ventricular ejection, and a second smaller peak, the tidal wave, presumed to represent a reflected wave from the periphery. The tidal wave may increase in amplitude in hypertensive patients or in those with elevated systemic vascular resistance. Radial and femoral pulse tracings demonstrate a single sharp peak in normal circumstances.
Pulsus bisferiens is characterized by two systolic peaks of the aortic pulse during left ventricular ejection separated by a midsystolic dip. Both percussion and tidal waves are accentuated. It is difficult to establish with certainty that the two peaks are occurring in systole with simple palpation (pulsus bisferiens) versus one peak in systole and the other in diastole (dicrotic pulse).
Etiology of pulsus bisferiens — Pulsus bisferiens is frequently observed in patients with hemodynamically significant (but not mild) aortic regurgitation. In patients with mixed aortic stenosis and aortic regurgitation, a bisferiens pulse occurs when regurgitation is the predominant lesion. The absence of pulsus bisferiens does not exclude significant aortic regurgitation.
In most patients with hypertrophic cardiomyopathy the carotid pulse upstroke is sharp and the amplitude is normal; pulsus bisferiens is rarely palpable but often recorded. The rapid upstroke and prominent percussion wave result from rapid left ventricular ejection into the aorta during early systole. This is followed by a rapid decline as left ventricular outflow tract obstruction ensues, a result of midsystolic obstruction and partial closure of the aortic valve. The second peak is related to the tidal wave. Occasionally, a bisferiens pulse is not present in the basal state but can be precipitated by Valsalva maneuver or by inhalation of amyl nitrite.
Pulsus bisferiens is occasionally felt in patients with a large patent ductus arteriosus or arteriovenous fistula. A bisferiens quality of the arterial pulse also is rarely noted in patients with significant mitral valve prolapse and, very rarely in normal individuals, particularly when there is a hyperdynamic circulatory state.
Mechanism of pulsus bisferiens — The mechanism of pulsus bisferiens is not clear. It appears to be related to a large, rapidly ejected left ventricular stroke volume associated with increased left ventricular and aortic dp/dt.
#Pulsusbisferiens #arterialpulses #Mechanismofpulsusbisferiens #pulse #usmle #nationalexittest #nationalexitexam
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📌𝗦𝘂𝗯𝘀𝗰𝗿𝗶𝗯𝗲 𝗧𝗼 𝗠𝘆 𝗠𝗮𝗶𝗹𝗶𝗻𝗴 𝗟𝗶𝘀𝘁:- https://linktr.ee/DrGBhanuprakash
PULSUS BISFERIENS
The normal carotid arterial pulse tracing and the central aortic pulse waveform consist of an early component, the percussion wave, which results from rapid left ventricular ejection, and a second smaller peak, the tidal wave, presumed to represent a reflected wave from the periphery. The tidal wave may increase in amplitude in hypertensive patients or in those with elevated systemic vascular resistance. Radial and femoral pulse tracings demonstrate a single sharp peak in normal circumstances.
Pulsus bisferiens is characterized by two systolic peaks of the aortic pulse during left ventricular ejection separated by a midsystolic dip. Both percussion and tidal waves are accentuated. It is difficult to establish with certainty that the two peaks are occurring in systole with simple palpation (pulsus bisferiens) versus one peak in systole and the other in diastole (dicrotic pulse).
Etiology of pulsus bisferiens — Pulsus bisferiens is frequently observed in patients with hemodynamically significant (but not mild) aortic regurgitation. In patients with mixed aortic stenosis and aortic regurgitation, a bisferiens pulse occurs when regurgitation is the predominant lesion. The absence of pulsus bisferiens does not exclude significant aortic regurgitation.
In most patients with hypertrophic cardiomyopathy the carotid pulse upstroke is sharp and the amplitude is normal; pulsus bisferiens is rarely palpable but often recorded. The rapid upstroke and prominent percussion wave result from rapid left ventricular ejection into the aorta during early systole. This is followed by a rapid decline as left ventricular outflow tract obstruction ensues, a result of midsystolic obstruction and partial closure of the aortic valve. The second peak is related to the tidal wave. Occasionally, a bisferiens pulse is not present in the basal state but can be precipitated by Valsalva maneuver or by inhalation of amyl nitrite.
Pulsus bisferiens is occasionally felt in patients with a large patent ductus arteriosus or arteriovenous fistula. A bisferiens quality of the arterial pulse also is rarely noted in patients with significant mitral valve prolapse and, very rarely in normal individuals, particularly when there is a hyperdynamic circulatory state.
Mechanism of pulsus bisferiens — The mechanism of pulsus bisferiens is not clear. It appears to be related to a large, rapidly ejected left ventricular stroke volume associated with increased left ventricular and aortic dp/dt.
#Pulsusbisferiens #arterialpulses #Mechanismofpulsusbisferiens #pulse #usmle #nationalexittest #nationalexitexam
4 سال پیش
در تاریخ 1399/08/05 منتشر شده
است.
55,622
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