Wednesday, 5 January 2011

Different arterial pulse waveforms and example causes

This is best assessed at the carotid artery. You are feeling for the speed at which the artery expands and collapses and force with which it does so. It takes some practise to master and it may be useful to imagine a graph such as those shown in the figure below,also Some examples are present:

Aortic stenosis: a slow rising pulse, maybe with a palpable shudder. Sometimes called anacrotic or a plateau phase.
Aortic regurgitation: a collapsing pulse which feels as though it suddenly hits your fingers and falls away just as quickly. You could try feeling at the brachial artery and raising the arm above the patient's heart. Sometimes referred to as a waterhammer pulse.
Pulsus bisferiens: a waveform with 2 peaks, found where aortic stenosis and regurgitation co-exist.
Hypertrophic cardiomyopathy: this pulse may feel normal at first but peter out quickly. Often described as jerky.
Pulsus alternans: an alternating strong and weak pulsation, synonymous with a severely impaired left ventricle in a failing heart.
Pulsus paradoxus: pulse is weaker during inspiration (causes include cardiac tamponade, status asthmaticus, and constrictive pericarditis).


Graphical representation of different arterial pulse waveforms and their causes

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