Imp abnormal types of pulses

1. AMITANAND
FINALYEAR
MBBS
Types of Arterial pulses

2. 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.

3. Anacrotic Pulse (Pulsus Tardus):
Low amplitude pulse with Slow rise and slow fall
Duration of pulse is prolonged
Seen 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 cardiomyopathy
Cardiac Tamponade
Dehydration
Typhoid fever

4. Collapsing or Water hammer pulse
corriagan,
Large volume pulse with Rapid upstroke and rapid down
stroke
Rapid 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 elevated
Causes:
Aortic regurgitation
PDA
Hyperdynamic states: Fever, Anaemia, Thyrotoxicosis,
pregnancy and AV fistula

5. Pulsus Bisferiens
It is single pulse wave with two peaks in systole
d/t ejection of rapid jet of blood through aortic valve
Best felt in brachial and femoral artery
AS + AR
Severe AR
HOCM(Hypertrophic obstructive cardiomyopathy)

6. 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

7. 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 Failure
Cardia 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

8. 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.

9. Cardiac temponade
Constrictive pericarditis
Acute asthma
Superior vana cava obstruction
Reverse pulsus paradoxus: It is an inspiratory rise in
arterial pressure.
Hypertrophic obstructive cardiomyopathy
Intermittent positive pressure ventilation
AV dissociaton

10. Thank You…