Page 52 - Clinical Pearls in Cardiology

40 Clinical Pearls in Cardiology

Another type of double beating pulse, with both
the palpable waves occurring in systole (like the pulsus
bisferiens) is the bifid pulse of hypertrophic obstructive
cardiomyopathy.
15. What are the special characteristics of the arterial
pulse in valvular aortic stenosis?
The normal rise of arterial pulse is felt as a sharp tap
by the palpating finger. The delayed upstroke in aortic
stenosis is felt as a gentle sustained push “shouldering”
the pulse. Characteristic changes in the morphology
of the arterial pulse can occur in the presence of fixed
left ventricular outflow tract obstruction, particularly
valvular aortic stenosis. The most important among them
are the following:
• Delayed upstroke of the ascending limb (i.e. pulsus
tardus): A delayed peak and slower upstroke of the
carotid pulse suggest a prolonged left ventricular
ejection time.
• Small amplitude (i.e. pulsus parvus): The amplitude
of the pulse decreases with the diminishing stroke
volume.
• Anacrotic character (i.e. anacrotic pulse): An
anacrotic pulse gives the impression of interruption
of the upstroke of the carotid pulse due to the slower
rate of pressure rise in the aorta.
16. What produces the “collapse” in collapsing pulse?
Two factors are mainly responsible for giving the
collapsing effect to arterial pulses with a high volume
and they are the following:
1. Loss of peripheral vascular resistance due to
vasodilatation (as in fever)