Page 51 - Clinical Pearls in Cardiology

Arterial Pulse and Blood Pressure 39

Another double peaking pulse is the pulses bisferiens.
The dicrotic pulse is frequently confused with pulsus
bisferiens at the bedside. Pulsus bisferiens is frequently
observed in patients with hemodynamically significant
aortic regurgitation or severe HOCM. In patients
with mixed aortic stenosis and aortic regurgitation,
the bisferiens pulse occurs when regurgitation is the
predominant lesion.
Pulsus bisferiens is characterized by two systolic peaks
of the arterial pulse that are separated by a midsystolic
dip. The two systolic peaks are due to the accentuated
percussion and tidal waves, respectively (Fig. 7). It is
difficult to establish with certainty that both the two
peaks are occurring in systole, with simple palpation
alone, in a patient with pulsus bisferiens. Hence it is
almost impossible to distinguish between the dicrotic
pulse and bisferiens pulse without a pulse tracing.
(Ref: Textbook of Cardiovascular Medicine, 3rd edition.
Eric J Topol; 1997).

Fig. 7: Tracing of pulsus bisferiens