Pulses

Pulsus parodoxus

• greater than the normal (10 mmHg) fall in systolic blood pressure during inspiration ‐‐> faint or absent pulse in inspiration

 severe asthma, COPD, cardiac tamponade or pericardial constriction, tension pneumothorax

Pulsus tardus et parvus or Anacrotic /Slow‐rising/plateau pulse

 aortic stenosis

Collapsing (waterhammer)

 aortic regurgitation

 patent ductus arteriosus

 AV malformation

 hyperkinetic (anaemia, thyrotoxic, fever, exercise/pregnancy)

Pulsus alternans (sign of LV systolic dysfunction)

• regular alternation of the force of the arterial pulse

 severe LVF, sometimes in cardiomyopathy, aortic stenosis

Pulsus bigeminus

HOCM may occasionally be associated with a bisferiens pulse

Bisferiens pulse

• 'double pulse' ‐  two systolic peaks

 AR or mixed aortic valve disease (combined AS and AR)

'Jerky' pulse