DR Medhat MRCP

Normal pulse in
young (25y) person
Slow-rising/plateau
pulse
Collapsing
(= water-hammer)
pulse
Pulsus alternans
Bisferiens pulse
'Jerky' pulse
Pulsus parodoxus
Arterial Pulses
The arterial pulse waveform is a contour wave generated by
the heart when it contracts & it travels along the arterial walls
of the arterial tree.
Generally, there are 2 main components of this wave:
a) Forward moving wave (= percussion wave)
- The forward wave is generated when the ventricles
contracts during systole.
- This wave travels down the large aorta from the heart
and gets reflected at the bifurcation of aorta
b) Reflected wave (= tidal wave)
- In a normal healthy person, the reflected wave usually
returns in the diastolic phase, after the closure of the
aorta valves.
- The returned wave give a notch (= dicrotic notch) and it
also helps in the perfusion of the heart through the
coronary vessels as it pushes the blood through the
coronaries.
Aortic stenosis (AS)
Aortic regurgitation (AR)
Patent ductus arteriosus (PDA)
Hyperdynamic circulation (anaemia, thyrotoxic, fever,
exercise/pregnancy).
Regular alternation of the force of the arterial pulse
Severe LVF
'Double pulse' - two systolic peaks
Mixed aortic valve disease (AS/AR)
(double pulse – double aorta)
HOCM
> normal (10 mmHg) fall in systolic blood pressure during
inspiration --> faint or absent pulse in inspiration
Severe asthma, cardiac tamponade
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