Pulsus bisferiens
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Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

, pulsus bisferiens, also bisferious pulse or biphasic pulse, is a sign where, on palpation
Palpation
Palpation is used as part of a physical examination in which an object is felt to determine its size, shape, firmness, or location...

 of the pulse
Pulse
In medicine, one's pulse represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone, such as at the neck , at the wrist , behind the knee , on the inside of the elbow , and near the...

, a double peak per cardiac cycle
Cardiac cycle
The cardiac cycle is a term referring to all or any of the events related to the flow or blood pressure that occurs from the beginning of one heartbeat to the beginning of the next. The frequency of the cardiac cycle is described by the heart rate. Each beat of the heart involves five major stages...

 can be appreciated. Bisferious means striking twice. Classically, it is detected when aortic insufficiency
Aortic insufficiency
Aortic insufficiency , also known as aortic regurgitation , is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle....

 exists in association with aortic stenosis, but may also be found in isolated but severe aortic insufficiency
Aortic insufficiency
Aortic insufficiency , also known as aortic regurgitation , is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle....

, and hypertrophic obstructive cardiomyopathy.

Normally, arterial pulses are best felt in central arteries like the brachial and carotid arteries, but this is not the case for pulsus bisferiens. It is felt best in the radial artery. Another such pulse which can be felt better in peripheral arteries is pulsus alternans
Pulsus alternans
Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis.-Pathophysiology:...

. The first lift is due to "percussion wave"(P) and the second lift is due to tidal wave (T).
  • If P>T - AR>AS
  • If T>P - AS>AR

External links


check harrisons book of medicine - 15 th edition page 1255 and 1305.
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