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Arterial pulse

  1. Types of Pulse
    1. Pulsus parvus et tardus (low amplitude with slow rise Q) Severe valvular AS. Some patients with AS may also have a slow, notched, or interrupted upstroke (anacrotic pulse, (LQ 2012) with a thrill or shudder
    2. Bisferiens pulse (Two systolic peaks)
      1. AR Q
      2. AR with AS Q ,
      3. HOCM Q
    3. Dicrotic pulse (Two waves – one is systole and one is diastole) Dilated cardiomyopathy Q.
    4. Pulses alternans (Regular alteration of amplitude with regular rhythm) Severe LVF. Q
    5. Pulses bigeminus (Premature beats following each regular beat) -  Digoxin therapy
    6. Pulsus paradoxus (decrease in systolic arterial pressure during inspiration)
      1. Pericardial tamponade. Q
      2. Severe COPD
      3. Bronchial Asthma.Q
      4. Sup. vena cava obstruction
      5. Constrictive pericarditis (rare)
      6. Pulmonary embolism
      7. Hypovolemic shock (Ref. Hari. 18th ed., pg -1825)
    7. Water hammer pulse / collapsing pulse /Corrigan’s pulse
      1. AR
      2. PDA
      3. A-V fistula
      4. Beri - Beri
      5. Hyperthyroidism
      6. Pregnancy
    8. Irregularly irregular – Atrial fibrillation (MCQ)
Extra Edge:
  1. Character  Best assessed in carotid artery.
    But Bisferiens pulse & pulsus alternans are best felt in peripheral artery (Radial Artery) (Ref. Hari. 18th ed., pg -1825)
    Jerky carotid pulses − HOCM
  2. Rhythm  Best assessed in peripheral artery – radial Q.
  3. Volume  Best assessed in carotid artery Q.
  4. Radio– femoral delay – seen in coarctation of aorta Q

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