18. Mechanism
ī In aortic regurgitation, during diastole:
īLeft ventricle receives
normal pulmonary venous return+portion of blood
ejected into the aorta => large stroke volume-
vigorously ejected=> rapidly rising carotid pulse
19. īCollapses in early diastole â backflow through
aortic valve
īExaggerated at the radial artery by liftng the
arm.
20.
21. Slow Rising Pulse
ī Gradual upstroke with a reduced peak
ī Occur late in systole
ī Seen in severe aortic stenosis
23. Pulsus Bisferiens
ī Increased pulse with double systolic peak
seperated by a distinct mid-systolic dip.
ī Causes:
īAortic regurgitation
īConcomitant aortic stenois and regurgitation
24.
25. Pulsus Parvus et Tardus
ī Weak and delayed pulse
ī Seen in conditions with:
ī diminished left ventricular stroke volume
īNarrow pulse pressure
īIncreased peripheral vascular resistance
īAortic stenosis
26.
27. Pulsus bigeminus
ī Regular alteration of pulse pressure
amplitude.
ī Caused by premature ventricular
contraction that follows each regular beat
ī Occurs in:
īAV block
īSinoatrial block withVentricular Escape
28.
29. Pulsus alternans
ī Beat-to-beat variation in pulse volume with a
normal rhythm.
ī Rare
ī Occurs in :
īAdvanced heart failure
īToxic myocarditis
īParoxysmalTachycardias
īFollowing Premature beat
30.
31. Pulsus Paradoxus
ī Exaggeration of the normal variability of
pulse volume with breathing.
ī Inspiratory decline in systolic pressure
greater than 10mm Hg.
ī Occurs in:
īCardiac tamponade
īConstrictive pericarditis
īPercardial effusion
32.
33. Anacrotic Pulse
ī Slow rising
ī Double beating pulse
ī Both waves felt in systole
īSeen in Aortic Stenosis
34.
35. Dicrotic Pulse
ī Twice beating
ī First wave in systole, second wave in
diastole
ī Seen when PR and DP is low
ī Felt due to hypotonia of vessel wall
ī Seen in:
īFever (e.g. typhoid fever)
īCCF
īCardiac Tamponade
36.
37. RADIO-FEMORAL DELAY
ī Most common cause: Coarctation of aorta
ī Children:
īUpperlimb pulses are usually normal
īReduced volume lowerlimb pulses
ī Adults:
īUsually presents hypertension and heart failure
ī Other causes:
âĸ Atherosclerosis of aorta
âĸ Thrombosis or embolism of aorta
38. OTHER PERIPHERAL
PULSATIONS
ī Normal-All pulsations felt equally
īAbsence of peripheral pulsations:
īļPeripheral vascular disease
īļCoarctation of aorta- decreased and delayed
femoral pulsation
īļTakayasuâs disease: decreased upper limb
pulsation
39. CAUSES OF ABSENT RADIAL
PULSE
ī Anatomical abnormality
ī Severe atherosclerosis
ī Takayasu arteritis (Pulseless disease)
ī Embolism in radial artery
ī Death
40. ABNORMAL FINDINGS IN
JUGULAR VENOUS PULSE
ī Raised in :
īRight sided heart failure caused by chronic
pulmonary hypertension in severe lung
disease(COPD)
īCor pulmonale
īIncreased intrathoracic pressure-tension
pneumothorax or severe acute asthma.
īMassive pulmonary embolism- very high JVP