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Types of Arterial pulses



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Types of Arterial pulses

  1. 1. AMITANAND FINALYEAR MBBS Types of Arterial pulses
  2. 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. 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. 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. 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. 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. 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. 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. 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. 10. Thank You…