Heart and Pulse Flashcards
Factors influencing the pulse:
- stroke volume
- rate of ejection
- distensibility of peripheral arteries
- peripheral resistance
- pulse rate
- pulse pressure
- size of the vessel
- distance from the heart
Features of a hypokinetic pulse
Weak pulse signifies low (narrow) pulse pressure small, weak
May be due to low CO, hypovolemia, valvular heart disease as seen in:
-left ventricular failure
-Ao valvular stenosis: pulsus parvus et tardus
characteristic anacrotic notch
Hyperkinetic pulse
High amplitude pulse with rapid rise (large volume and wide pulse pressure)
High output states: fever, anemia, beri beri
Mitral regurg
Dicrotic pulse
The twice beating pulse
A pulse in systole followed by a second pulse wave palpable during diastole, (following S2)
peripheral resistance diastolic BP
fever, moderate AI
Anacrotic pulse
A palpable slow rising or double pulse both in systole, before S2
Associated with Aortic Stenosis
Bisferiens pulse (biphasic pulse)
On palpation a double peak/cycle can be felt Seen in HOCM
a very rapid initial upstroke the “percussion wave” is followed by a “dip” (the obstruction decelerates the ejection), this is followed by a second positive wave “tidal wave”
Pulsus alternans
Alternating strong and weak beats
Regular pulse with an alternating height of the pressure pulse + often S3 : a sign of heart (LV) failure
Bigeminal pulse
Two groups of heart beats close together followed by a longer pause. The second beat may be weaker than the first.
Pulsus Paradoxus
An abnormally large decrease in SBP and pulse wave amplitude during inspiration. Normally less than 10 mmHg
Paradox- hear beats when ausculation but cannot feel them at radial pulse (due to accentuated decrease of BP)
cardiac tamponade constrictive pericarditis
Estimation of venous pressure
Estimated at the bedside
1. Veins of the hand: passive elevation to and
above the sternal angle
2. External jugular: trunk elevated to 30-60
occlude the vessel by pressing with finger above the clavicle, it fills within 15-40 s
release and observe the fluid column
3. Paradox increase in venous distension during inspiration “Kussmaul sign”
constrictive pericarditis
4. Hepatojugular reflux
JVP
The jugular venous pulsation has a biphasic waveform.
The upward deflections are the “a” (atrial contraction), “c” (ventricular contraction and resulting bulging of tricuspid into the right atrium during isovolumetric systole) and “v” = venous filling
The downward deflections of the wave are the “x” (the atrium relaxes and the tricuspid valve moves downward) and the “y” descent (filling of ventricle after tricuspid opening).
Corrigan’s pulse
Watson’s water hammer pulse
or collapsing pulse,
A pulse that is bounding and forceful,
rapidly increasing and subsequently collapsing like a waterhammer.
Associated with: Aortic Regurgitation
increased stroke volume of the left ventricle decreased peripheral resistance –> leading to the widened pulse pressure
Corrigan’s pulse
AKA Watson’s water hammer pulse
or collapsing pulse
A pulse that is bounding and forceful,
rapidly increasing and subsequently collapsing like a waterhammer.
Associated with: Hyperdynamic circulation and Aortic Regurgitation
Hyperdynamic Circulation
An increased circulatory volume increased vasodilation and decreased peripheral resistance–> presents with collapsing pulse
Hypervolemia Anemia Anxiety Aortic Regurgitation AV fistulae Beriberi Exercise Liver failure Paget's disease Portal hypertension Pregnancy Pyrexia Thyrotoxicosis Vasodilator drugs
A Wave
The “ a “ wave corresponds to right Atrial contraction and ends synchronously with the carotid artery pulse. The peak of the ‘a’ wave demarcates the end of atrial systole.
