The document describes several types of arterial pulses: 1) Anacrotic pulses have a low amplitude with a slow rise and fall and are seen in aortic stenosis. Dicrotic pulses have two peaks, one in systole and one in diastole, and are caused by low stroke volume and decreased peripheral resistance. 2) Collapsing or water hammer pulses have a rapid upstroke and downstroke due to increased stroke volume and decreased peripheral resistance, seen in aortic regurgitation and other conditions. 3) Pulsus bisferiens has two peaks in systole, best felt in the brachial and femoral arteries and caused by conditions like aortic stenosis and regurgitation.

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…