Bisferiens Pulse

Bisferiens pulse, and concludes that though suggestive of aortic stenosisthe condition is not diagnostic. I havediffered fromDr. Steell in theuseof theterms'anacrotic' and'bis-feriens,'usingtthe term 'bisferiens' when speaking of the pulse, since it conveysthe ideaof the double effort onefeels withthefinger in thesecases, and the term. Pulsus bisferiens, also known as biphasic pulse, is an aortic waveform with two peaks per cardiac cycle, a small one followed by a strong and broad one. It is a sign of problems with the aorta, including aortic stenosis and aortic regurgitation, as well as hypertrophic cardiomyopathy causing subaortic stenosis.

Cardiology , general examination , notes , practical notes , pulse , vitals monitoring

Pulsus bisferiens is a high volume double-beating pulse which has single pulse wave with two peaks in systole

.It is best palpated In large arteries like brachial and carotid arteries.

The first lift is due to P wave (percussion wave) and the second lift is due to T or tidal wave.

and if the T>P. usually AS>AI.
AS-Aortic stenosis
AR-Aortic regugitation

So this will help us to determine the dominant lesion in valve

Combined AS and Al (commonest).
Isolated Al.
IHSS.

What is the pathophysiology of Pulses bisferiens?

This is due to the 'ventury effect' within the left ventricle

Another view explains that the dip in the pulse is felt due to energy dissipation in the productlon of a loud systolic murmur of AS..

Pulses bisferiens is better felt over the proximal vessels like Carotid and brachial artery.

Bisferiens Pulse Pronunciation

With your fingers, try to press and occlude the brachial artery. On slowly releasing the pressure, you may feel the double peaking of the pulse.
The first component of the pulse is due to large volume of blood ejected in systole and the second component is produced due to elastic recoil in the arteries This is the best reasoning

Three different causes of double-beating pulse are

Bisferiens Carotid Pulse

Bisferiens pulse.
Anacrotic pulse
Dicrotic pulse.

Bisferiens Pulse Is Characteristically Found In

Bifid And Bisferiens Pulse

Pathogenesis

In hypertrophic cardiomyopathy, there is narrowing of the left ventricular outflow tract (LVOT) due to hypertrophy of the interventricular septum. During systole, the narrowing of the LVOT creates a more negative pressure due to the Venturi effect and sucks in the anterior mitral valve leaflet. This creates a transient occlusion of the LVOT, causing a midsystolic dip in the aortic waveform. Towards the end of systole, the ventricle is able to overcome the obstruction to cause the second rise in the aortic waveform.^[2]

In severe aortic regurgitation, additional blood reenters the left ventricle during diastole. This added volume of blood must be pumped out during ventricular systole. The rapid flow of blood during systole is thought to draw the walls of the aorta together due to the Venturi effect, temporarily decreasing blood flow during midsystole.^[2]

Pulsus Alternans

A recent paper theorized that an alternative explanation for pulsus bisferiens may be due to a forward moving suction wave occurring during mid-systole.^[3]