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Understanding Clinical Pulse Patterns

Sep 9, 2024

Lecture Notes on Pulse Patterns

Introduction to Pulse

  • Definition: A pressure wave generated by the left ventricular contraction, moving along the arterial tree and creating a palpable impulse.
  • Best felt in: Carotid and Radial arteries.
  • Normal Pulse: Concentrate on the upward movement of the finger and note the amplitude of the normal percussion wave.

Types of Pulses in Diseases

1. Hyperkinetic or Bounding Pulse

  • Description: High pulse pressure; high amplitude.
  • Causes:
    • Increased stroke volume (e.g., aortic regurgitation, post-exercise).
    • Low peripheral resistance (e.g., fever, severe anemia, thyroid toxicosis, cirrhosis).

2. Water Hammer or Collapsing Pulse

  • Description: Very quick rising and falling pulse.
  • Best felt in: Forearm with arm raised.
  • Associated with: Severe aortic regurgitation.
  • Characteristics: Rapid upstroke and immediate decline.

3. Pulses Parvas (Low Volume Pulse)

  • Description: Low volume, small amplitude pulse.
  • Causes:
    • States of hypovolemic shock.
    • Aortic stenosis.
  • Characteristics: Slow rise and fall with low amplitude.

4. Pulsus Tardus

  • Description: Slow rising pulse.
  • Associated with: Severe aortic stenosis and systolic thrill in carotids.

Other Pulse Patterns

5. Dichrotic Pulse

  • Description: Two beats per cycle (normal percussion wave + early diastole wave).
  • Causes: High vascular resistance causing exaggerated dichrotic wave.
  • Characteristics: Felt immediately after S2.

6. Anacrotic Pulse

  • Description: Low amplitude, slow rising pulse.
  • Associated with: Severe aortic stenosis.
  • Characteristics: Anacrotic wave felt on upstroke of pulse.

7. Pulses Bisferiens

  • Description: Two peaks in the pulse; prominent percussion wave and tidal wave.
  • Characteristics: Seen in conditions like hypertrophic obstructive cardiomyopathy (HOCM) and aortic stenosis + aortic regurgitation.

8. Pulses Alternans

  • Description: Alternate high and low volume pulse.
  • Causes: Alternate normal and weak ventricular contractions; commonly seen in left ventricular failure.

9. Pulsus Bigeminus

  • Description: Normal pulse followed by a premature beat, then a compensatory pause.
  • Common in: Digitalis toxicity.

10. Pulsus Paradoxus

  • Description: Significant decrease in pulse volume during inspiration.
  • Causes: Increased right ventricular volume during inspiration; bulging of interventricular septum into left ventricle.
  • Associated with: Cardiac tamponade, constrictive pericarditis, and superior vena cava obstruction.

Revision Summary

  • Key Pulse Patterns:
    • Hyperkinetic or Bounding Pulse
    • Water Hammer or Collapsing Pulse
    • Pulses Parvas (Low Volume Pulse)
    • Pulsus Tardus
    • Dichrotic Pulse
    • Anacrotic Pulse
    • Pulses Bisferiens
    • Pulses Alternans
    • Pulsus Bigeminus
    • Pulsus Paradoxus

This summary provides a comprehensive overview of different pulse patterns and their clinical significance.

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