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Old 12-10-2011
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Stethoscope One heart beat for each two-pulse waves!

While palpating the pulse of a patient, you note that the pulse wave has two peaks. You auscultate the heart and are certain that there is only one heartbeat for each two pulse waves. Which of the following best describes this finding?

a. Pulsus alternans
b. Dicrotic pulse
c. Pulsus parvus et tardus
d. Pulsus bigeminus
e. Pulsus bisferiens
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Old 12-10-2011
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Default Pulsus bisferiens

Pulsus bisferiens >> Aortic insufficiency
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dicrotic pulse
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Is it Dicrotic pulse?
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dicrotic notch is a feature of the JVP which is not palpable and only a pressure tracing artefact. Pulsus bisferiens is dual peaked palpable pulse... occurs in AI i think...
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Answer (e) pulsus bisferiense
bisferiens = biphasic pulse = two pellagra pulse peaks per cardiac cycle (Bisferious means is the Latin word for Beat twice). Classically
Causes: Combined aortic regurgitation and aortic stenosis
Severe aortic regurgitation, HCM

Pulsus alternates: answer (a)
Is the alternating strong and weak pulses because of alternating strong and weak cardiac contraction. Some weak impulses are so weak that they cannot reach to the radial artery. The most important cause for that is heart failure and dilated cardiomyopathy.

Dicortic pulse: answer (b)
Is a wave reflection from the peripheral arteries causing a systolic notch (looks like bisferiense however double peaking occurs only in systole compared to staple diastole peaking in bisferiense) it results from the accentuated diastolic dicrotic wave that follows the dicrotic notch.
Causes decreased systemic arterial pressure and vascular resistance (eg, fever), severe heart failure, hypovolemic shock, cardiac tamponade, conditions associated with a decreased stroke volume and elevated systemic vascular resistance, and during the immediate postoperative period following aortic valve replacement.

Pulsus Parvus and Pulsus answer(c)
Diminished and delayed arterial pulsations. causes including aortic stenosis or central arterial stenosis.

Pulsus bigeminus: answer (d)
Is nothing but a reproduction of the bigemini of the ECG which is complete two cardiac beats groupd together and separated from the next 2 by a long pause. The first beat should be normal sinus beat and the second one should be either atrial or ventricular premature beat
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