PULSES

PULSUS ALTERANS
• regular alteration of the pressure pulse
amplitude, despite regular rhythm
• Cause: alternating left ventricular contractile
force
• Indication: severe impairment of left ventricular
function
• May occur:
a) in patients who have loud third heart sounds
b) During or following a paroxismal tachycardia or for
several beats following a premature for patients
without heart disease
 PULSUS BIGEMINUS
• regular alteration of the pressure pulse
amplitude, BUT it is caused by PVC’s that
follows each regular beat.
 PULSUS PARADOXUS
• A decrease in the systolic arterial pulse pressure
greater than 10mmhg during inspiration
• Causes:
A. cardiac
1. Cardiac tamponade
2. Pericardial effusion
3. Constrictive pericarditis
4. Restrictive cardiomyopathy
5. Pulmonary embolism
6. Acute myocardial infarction
7. Cardiogenic shock
B. Extracardiac pulmonary causes
1. Bronchial asthma
2. Tension pneumothorax

C. Extracardiac non-pulmonary causes

1. Anaphylactic shock (during urokinase
administration)
2. Volvulus of the stomach
3. Diaphragmatic hernia
4. Superior vena cava obstruction
5. Extreme obesity
 • Has two systolic peaks
separated by
midsystolic dip
PULSUS • Cause:
BISFERIENS a)aortic regurgitation
with or without
accompanying stenosis
b)hyperthropic
cardiomyopathy
 PULSUS PARVUS
• Small weak pulse
• Indication:
a) diminished left ventricular
stroke volume
b) narrow pulse pressure
c) increased peripheral vascular
resistance
PULSUS TARDUS
• Slow/delayed pulse in
relation to cardiac
contraction
• Due to obstruction to left
ventricular ejection
 PULSUS DIFFERENS
• inequality of the pulse observable at
corresponding sites on either side of
the body.