Page 50 - Clinical Pearls in Cardiology

38 Clinical Pearls in Cardiology

14. How will you differentiate a dicrotic pulse from pulsus
bisferiens?
A dicrotic pulse (also known as twice-beating pulse)
results from the accentuated diastolic dicrotic wave
that follows the dicrotic notch. So the dicrotic pulse is
a double peaking pulse with two peaks. The first peak
in systole is due to the percussion wave and the second
peak in diastole is due to the accentuated dicrotic wave
(Fig. 6). It tends to occur in patients with decreased
systemic arterial pressure and peripheral vascular
resistance. It is seen in the following situations:
• Septic shock
• Febrile states, especially typhoid fever
• Severe heart failure
• Hypovolemic shock
• Cardiac tamponade
• Immediate postoperative period following aortic
valve replacement

Fig. 6: Tracing of dicrotic pulse