Arterial pulse waveform is composed of percussion wave travelling along artery which is at a much higher speed than the actual passage of blood with a dicrotic notch which represents the closure of the aortic valve.
| Pulse characteristics | 
|---|
| Good volume | Normal | 
| Bounding | High output e.g. post exercise, thyrotoxicosis, fever, Hyperdynamic circulation, severe Paget's disease | 
| Collapsing pulse | Aortic regurgitation or AV fistula. Low diastolic pressure. Wide pulse pressure. | 
| Plateau pulse | Slow rising small "pulsus parvus" seen with Aortic stenosis. Narrow pulse pressure. | 
| Jerky pulse | Hypertrophic obstructive cardiomyopathy | 
| Pulsus Bisferiens | Mixed collapsing and plateau pulse with mixed aortic valve disease | 
| Pulsus alternans | Alternating large and small beats and suggests severe LV dysfunction | 
| Pulsus bigeminus | caused by a premature beat before every QRS complex | 
| Pulsus paradoxus | Normal BP fall with inspiration is exaggerated > 10 mmHg. Feel pulse weakens with inspiration. Consider Cardiac Tamponade, pericardial constriction and acute severe asthma where inspiration will affect cardiac filling. Pulse weakens during inspiration. | 
 
| Absent | dissection if aorta with ipsilateral subclavian involved, arterial thrombosis or embolism in subclavian or brachial or may be seen post catheterisation (angiography now done via radial artery), Takayasu's disease | 
| Radiofemoral delay | Suggests Coarctation of aorta. Be sure to check blood pressure at arm and leg if suspicious. |