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Types of Arterial pulses

Pulse:The pulse is a wave form that is felt by fingers

and produced by cardiac systole which travels through the peripheral arterial tree in peripheral direction at a rate more faster than that of blood columm.

Anacrotic Pulse (Pulsus Tardus):Low amplitude pulse with Slow rise and slow fallDuration of pulse is prolongedSeen In aortic stenosis

Dicrotic Pulse:(Pulsus Dicrotius)It has two palpable waves with One peak in

systole, one in diastole.It due to a very low stroke volume with decreased peripheral resistance.

LVF, Dilated cardiomyopathyCardiac TamponadeDehydrationTyphoid fever

Collapsing or Water hammer pulsecorriagan, Large volume pulse with Rapid upstroke and rapid

down strokeRapid up stroke is because of increased stroke

volume Rapid downstroke is due to decrease in peripheral

resistance and diastolic leak back into left ventricles.

Best felt in radial artery with patient’s arm elevatedCauses:

Aortic regurgitation PDAHyperdynamic states: Fever, Anaemia, Thyrotoxicosis,

pregnancy and AV fistula

Pulsus Bisferiens It is single pulse wave with two peaks in

systoled/t ejection of rapid jet of blood through aortic

valve Best felt in brachial and femoral artery AS + ARSevere ARHOCM(Hypertrophic obstructive cardiomyopathy)

Pulsus Parvus:Small volume pulse like anacrotic pulse but

anacrotic wave is not felt.It occurs as a result of a reduction in left

ventricular stroke volume or decrease in systemic arterial pressure .

Severe Hypotension (Shock)Severe AS PS

Pulsus Alternans:Alternate large and small volume pulse,with a normal

rhythm.There is a difference of 10-40 mmHg in systolic pressure between beats .

Due to alternate left ventricular contractile force ie,the ventricles beats strongly ,then weakly ,alternating with each other.

LV FailureCardia Arrythmias

Pulsus bigeminus:A Pulse wave with normal beat followed by pre

mature beat and compensatory pause,thereby producing irregular rhythm .

It is caused by coupled ectopic beats ie,an ectopic beat following each regular beat .

Digitalis toxicity

Pulsus paradoxus:Exaggerated decrease in strength of arterial

pulse during inspiration, Inspiratory fall of SBP >10mmHg

The radial pulse gets smaller in volume with inspiration and larger in volume with expiration .

In this during inspiration the increased right ventricular volume results in bulging of interventricular septum into left ventricular cavity.This results in reduction in left ventricular volume leading to a further reduction in cardiac output.This exaggerats the normal inspiratory reduction in blood pressure ,allowing it to exceed 10mmHg.

Cardiac temponadeConstrictive pericarditisAcute asthmaSuperior vana cava obstruction

Reverse pulsus paradoxus: It is an inspiratory rise in arterial pressure.Hypertrophic obstructive cardiomyopathyIntermittent positive pressure ventilationAV dissociaton

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