How do you detect pulsus bisferiens?

Published by Anaya Cole on

How do you detect pulsus bisferiens?

Pulsus bisferiens can be more pronounced by the Valsalva maneuver. On palpation of a peripheral pulse (radial artery), two upstrokes distinguished by a mid-systolic gap in the systole are characteristic of pulsus bisferiens. Jugular venous pressure (JVP) examination may reveal classical ‘a’ wave in HOCM.

What is a double systolic peak?

Pulsus bisferiens or double pulse refers to a wave pattern where there is the presence of two systolic peaks that can be seen in pressure tracings of the ascending aorta, the aortic arch, and the carotid artery.

What is bifid pulse?

Bifid pulse with systolic and diastolic peaks represents a character abnormality of the pulse. It indicates low cardiac output state. The incisural notch becomes prominent with respect to the overall arterial pulsation in low cardiac output state generating the classical M-shaped waveform of the dicrotic pulse.

How do you test for pulsus paradoxus?

To measure pulsus paradoxus all you need is a stethoscope and a blood pressure cuff. To test for pulsus paradoxus slowly look for the first quarter cough sound. That will appear then disappear during inspiration. Next slowly listen for when the first quarter cough sound no longer disappears with inspiration.

Why does pulsus bisferiens cause aortic stenosis?

The bisferiens pulse in severe aortic regurgitation has been attributed to a Venturi effect that occurs in the ascending aorta in mid-systole due to the high flow produced by ventricular ejection.

Why does HOCM cause pulsus bisferiens?

Hypertrophic Cardiomyopathy Pulsus bisferiens is due to systolic anterior motion (SAM) of the mitral valve. Because the mitral valve leaflet doesn’t get pulled into the left ventricular outflow tract (LVOT) until after the aortic valve opens, the initial upstroke of the arterial pulse pressure will be normal.

What are biphasic pulses?

Pulsus bisferiens, also known as biphasic pulse, is an aortic waveform with two peaks per cardiac cycle, a small one followed by a strong and broad one. It is a sign of problems with the aorta, including aortic stenosis and aortic regurgitation, as well as hypertrophic cardiomyopathy causing subaortic stenosis.

How do you use the pulsus paradoxus with a Doppler?


  1. Inflate the bladder quickly to 20 mmHg above the pressure at which radial pulse is blocked.
  2. Deflate the bladder 3 mmHg/sec, record the pressure at which the first Korotkoff sound is heard as the systolic pressure.
  3. Continue deflating, record the disappearance of Korotkoff sounds as the diastolic pressure.

Why does HOCM cause Bisferiens pulse?

How do you check Pulsus Paradoxus?

Is bigeminy life threatening?

When this happens, blood can pool in your atria and a clot can form. If the clot escapes your heart and makes its way up to your brain, it can cause a potentially fatal stroke. The additional workload on your heart caused by the extra beats may lead to enlargement of the heart and possibly heart failure.

What is monophasic pulse?

Monophasic pulse shapes (often referred to as ‘single pulse’) are predominantly used for testing the integrity of the cortico-spinal pathway, assessing interhemispheric inhibition and evaluating the excitability of corticocortical connections.

How do you measure pulsus paradoxus?

Measurement of pulsus paradoxus Pulsus paradoxus is traditionally measured using a sphygmomanometer. The brachial cuff must be inflated above the presumed value of systolic arterial pressure and then deflated slowly to find the highest pressure at which the first Korotkoff sound is heard, normally during expiration.

What is a Bigeminal pulse?

Definition of bigeminal pulse medicine. : a pulse characterized by two beats close together with a pause following each pair of beats.

What is pulsus bisferiens in aorta?

When the two waves are discernable at the bedside, it is known as pulsus bisferiens. It is most often associated with the combination of aortic stenosis and aortic regurgitation, but is sometimes seen in patients with pure aortic regurgitation.

What is pulsus bisferiens (biphasic wave)?

This is derived from the Latin word, which means strike twice (bis=twice, ferio=strike). It is also called a biphasic wave. Way back in 1952, it was described by Galen in De Pulsibus. Pulsus bisferiens is associated with the severe aortic disease with aortic regurgitation and HOCM.

What is the difference between pulsus bisferiens and dicrotic pulse?

The main distinguishing feature of pulsus bisferiens is that two peaks are seen in systole whereas, the dicrotic pulse is characterized by one peak in systole and other in diastole. Dicrotic pulse is seen in the low cardiac output state, sepsis, and cardiac tamponade.