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. |