Bisferiens pulse (Pulsus bisferiens)

Bisferiens pulse may be seen in all of the following except:
1. Free aortic regurgitation
2. Combination of aortic regurgitation and stenosis
3. Hypertrophic obstructive cardiomyopathy
4. Fallot’s tetralogy
Correct answer: 4) Fallot’s tetralogy
Bisferiens pulse (pulsus bisferiens) has two systolic peaks and is seen in both free (severe) aortic regurgitation and a combination of aortic regurgitation and stenosis, especially when the regurgitation is dominant. In severe aortic stenosis, the pulse is low volume and slow peaking – pulsus parvus et tardus. In hypertrophic obstructive cardiomyopathy (HOCM), soon after the initial rapid ejection of blood into the aorta, the dynamic left ventricular outflow tract obstruction comes into play and reduces the volume of the pulse, followed by a delayed additional peak of lesser amplitude, giving a bisferiens nature. The pulse in HOCM is most often felt as a jerky pulse rather than as true bisferiens. Hypertrophic non obstructive cardiomyopathy (HNOCM) does not cause a bisferiens pulse.
In Fallot’s tetralogy, a high volume pulse can be felt because outputs from the left ventricle and part of the right ventricular output by right to left shunting across the ventricular septal defect (VSD) reach the aorta. Only a small portion of the right ventricular output reaches the pulmonary artery due to the obstruction of right ventricular outflow tract (subpulmonic stenosis). Dual peaking bisferiens pulse is not a feature of ...

Source: Cardiophile MD - April 16, 2014 Category: Cardiology Authors: Johnson Francis Tags: Cardiology MCQ Source Type: blogs