Thursday, December 16, 2010

Shapes of Arterial pressure waves

While palpating the pulse of a patient, you note that the pulse wave has two peaks. You auscultate the heart and are certain that there is only one heartbeat for each two
pulse waves. Which of the following best describes this finding?
  1. a.Pulsus alternans
  2. b.Dicrotic pulse
  3. c.Pulsus parvus et tardus
  4. d.Pulsus bigeminus
  5. e.Pulsus bisferiens

. The answer is: ( e ).
 Pulsus bisferiens (bisferious pulse) is seen in AI and in hypertrophic cardiomyopathy (HCM). In the latter, the first wave or percussion wave is due to the rapid flow rate of initial contraction, and the second wave or tidal wave is due to the slower rate of continued contraction. The dicrotic pulse has two palpable pulses, but one is in systole and the other is in diastole.

Pulsus bigeminus is an alteration in pulse amplitude that follows a ventricular premature beat. Pulsus alternans is a regular alternating pulse amplitude due to alternating left ventricular contractile force; it is usually seen with severe left ventricular decompensation and cardiac tamponade. Pulsus parvus et tardus(“small and slow rising”) represents a delayed systolic peak due to obstruction to left ventricular ejection. It is seen in aortic stenosis (AS)


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