Assessing The Pulses Flashcards
Predominant monophasic pulse appreciated at bedside
Incident (percussion) wave
Begins just after s1
Incisura or dicrotic notch corresponds to
Aortic valve closure
Bounding pulses may occur in
Hyperkinetic states - fever anemia thyrotoxicosis or in bradycardia, ar or av fistula
Bounding pulses may occur in
Hyperkinetic states - fever anemia thyrotoxicosis or in bradycardia, ar or av fistula
Bifid pulse created by two distinct pressure peaks
May occur in pxs with fever or after exercise in normal persons consistent with increased vascular compliance
In chronix severe AR, large stroke volume ejected rapidly in noncompliant arterial tree produces a reflected wave sufficient to be palpated in systole redering the pulse bifid
Other causes of bifid pulse
Hcom - rare
Diastolic augmentation of pressure in intra aortic balloon pump seperated by aortic valve closure
Explain pulsus paradoxus
a fall in systolic pressure of more than 10 mmHg with inspiration
Where is pulsus paradoxus observed
pericardial tamponade or pulmonary disease
obesity and pregnancy
how is pulsus paradoxus obtained
note the difference between the systolic bp (at which the Korotkoff sounds are first heart -during expiration and the systolic bp at which the Ksounds are heard with each beat independent of respiratory phase
Is pulsus paradoxus specific for cardiac tamponade?
No. it may also be caused by masssive PE, hemorrhagic shock, severe obstructive lung disease or tension pneumothorax
Define pulsus alterans
defined by beat to beat variability of the pulse amplitude.
where is pulsus alterans observed
severe heart failure, severe AR, hypotension and hypovolemic states
Physiology behind pulsus alterans
cyclic changes in intracellular calcium and action potential duration (ECG: T wave alterans)
Explain pulsus parvus et tardus
weak and delayed pulse
Severe Aortic stenosis
what is Corrigan or water-hammer pulse
an abrupt carotid upstroke with rapid fall off - Chronic AR
carotid upstroke is also rapid in older px with isolated systolic hpn and wide pulse pressures
