normal apples hyperkinetic or bounding bulbs water hammer or collapsing pulse pulses Purvis or low volume pulse Pulsar was a tireless dichrotic pulse anacrotic pulse pulses this variance pulses alternates pulses by geminus pulses paradoxes pulse is a pressure wave generated by the left ventricular contraction which rapidly moves along the arterial tree distending their walls and creating a palpable impulse it is best felt in the Carotid and Radial arteries this is normal pulse concentrate only on the upward movement of the finger and note the amplitude of the normal percussion wave now we will study the patterns of the pulse felt in different diseases hyperkinetic or bounding or high volume pulse occurs due to high pulse pressure which may be due to increased stroke volume as in aortic regurgitation or after exercise or due to low peripheral resistance as in Fever severe anemia thyroid toxicosis or cirrhosis note the high amplitude of the pulse raising the finger more than normal this is hyperkinetic or bounding pulse any extreme of bounding pulse is water hammer or collapsing pulse or corygan's pulse a very quick rising and quick falling pulse it is best felt in the forearm with arm raised and is seen in severe aortic regurgitation rapid upstroke and immediate rapidly sent this is the collapsing or water hammerables pulses parwas is a low volume pulse seen in states of hypovolemic shock and aortic stenosis here the amplitude or degree of expansion of the pulse is very small this is pulses pervas or low volume pulse foreign this is the low volume pulse which Rises slowly and Falls slowly note the slow rise and the slow fall and the low amplitude this is pulsargus that is low amplitude at tireless that is slow Rising seen in severe aortic stenosis it is usually associated with a systolic thrill in the carotids now we will come to twice beating pulse that is there is an additional wave felt in addition to the normal percussion wave in each cycle in dichrotic pulse there are two bits per cycle one incisely that is normal percussion wave and one in early diastole due to high vascular resistance producing an exaggerated dichrotic wave watch the finger this is dichrotic pulse which beats once in sisterly and once in diastole immediately after S2 thank you anachronotic pulse seen in severe aortic stenosis it is a low amplitude slow Rising pulse that is pulses perverse with anachronotic wave felt on the upstroke of the pulse observe these anacrotic pulse note the anacortic wave on the upstroke of the pulse that is before the main percussion wave ends pulses of experience has two peaks both in sisterly percussion wave and tidal wave due to ejection of Rapid jet of blood through narrow aortic wall percussion wave is more prominent in hocm while the tidal wave is equal or more prominent in a s plus a r now we shall see some other patterns of pulse pulses alternates here we feel alternate high volume and low volume pulse due to alternate normal and weak ventricular contractions seen in left ventricular failure alternate high and low volume pulse though the rhythm is normal this is pulses alternates pulses by geminus a normal pulse followed by a premature bead that is early occurring pulse and then a compensatory boss commonly seen in digitalis toxicity clinically it is felt as two close pulse waves followed by a pause pulses paradoxes if the pulse volume significantly decreases during inspiration it is termed as pulses paradoxes this is due to increased right ventricular volume during inspiration with bulging of interventricular septum into left ventricle causing reduction in its volume and cardiac output pulses paradoxes is seen in cardiac tamponade constructive and superior vena cava obstruction back to normal pulse as we come to the revision section hyperkinetic or bounding pulse water hammer or collapsing pulse pulses parvas or low volume pulse pulses parvas eternus dichrotic pulse anacrotic pulse pulses bisvariance pulses alternates pulses by geminus pulses paradoxes