CLINICAL-PULSE CHARACTERISTICS
SUMMARY
1. AF - pulse varies in rate + amplitude, due to irregular ventricular filling. Exhibits pulse deficit (HR by auscultation > radial pulse).
2. Sinus arrhythmia - HR increases with inspiration, decreases with expiration.
3. Frequent ectopics - ventricular vs. atrial. Bigeminy (every 2nd beat is an ctopic) vs. trigeminy (every 3rd beat is an ectopic).
4. Radio-radial delay - subclavian artery stenosis, thoracic aortic dissection, occlusion by thrombus/aneurysm.
5. Radio-femoral delay (Brachiofemoral delay) - aortic coarctation (congenital narrowing of the aortic isthmus at the level of the ductus arteriosus joining the descending aorta).
6. Water-hammer/collapsing pulse (Pulsus parvus et tardus) - aortic coarctation.
7. Pulsus paradoxus - decreased pulse amplitude with inspiration, drop of SBP > 10mmHg on inspiration.
8. Pulsus bisferiens - bifid pulse, with 2 systolic peaks per cardiac cycle. Seen in AR & HCM.
9. Pulsus alternans - varying pulse pressure with a regular HR, seen with severely depressed SV.
10. Pulsus parvus et tardus - low amplitude & slow upswing, seen in AS.
Reference(s)
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
