Editor-In-Chief:C. Michael Gibson, M.S., M.D.[1]

PULSUS BISFERIENS. TH BRITIs 7 After a while, the patient began to make steadythough slow progress, and with the exceptionof occasional severe attacksof dyspnceatherewasnothingof particular note. On March 2nd it was noted that the expectoration was muco-purulent, muchless in quantity, and absolutelyodour-less. Thank you for your interest in spreading the word about The BMJ. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail.

Synonyms and Keywords: Bisferious pulse, biphasic pulse, spike and dome pattern

From uptodate: Pulsus Bisferiens: 'The normal carotid arterial pulse tracing and the central aortic pulse waveform consist of an early component, the percussion wave, which results from rapid left ventricular ejection, and a second smaller peak, the tidal wave, presumed to represent a reflected wave from the periphery.

Overview

Pulsus bisferiens is a sign where, on palpation of the pulse, a double peak in the aortic waveform is observed with each cardiac cycle.

Bisferious means striking twice. Therefore, pulsus bisferiens is a type of aortic waveform which has two systolic peaks separated by distinct mid-systolic dip

Pathophysiology

Hypertrophic Cardiomyopathy

Pulsus bisferiens is due to systolic anterior motion (SAM) of the mitral valve. Because the mitral valve leaflet doesn't get pulled into the left ventricular outflow tract (LVOT) until after the aortic valve opens, the initial upstroke of the arterial pulse pressure will be normal. When the mitral valve leaflet gets pushed into the LVOT, the arterial pulse will momentarily collapse and will later be followed by a second rise in the pulse pressure, as the left ventricular pressure overcomes the increased obstruction caused by the SAM of the mitral valve. This can be seen on the physical examination as a double tap upon palpation of the apical impulse and as a double pulsation upon palpation of the carotid pulse, known as pulsus bisferiens or a 'spike and dome pattern' to the carotid pulse.

Causes Of Pulsus Bisferiens

Overview

Pulsus bisferiens classically detected in patients with mixed aortic insufficiency and aortic stenosis, but it may also be found in isolated severe aortic insufficiency, and hypertrophic obstructive cardiomyopathy.

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Pulsus bisferiens in itself is not a life threatening condition, but in most of cases it indicate aortic insufficiency, and further investigations should be done.

Common Causes

The most common cause of pulsus bisferiens is sever aortic insufficiency , other causes include:

• Aortic valve regurgitation Mixed with aortic stenosis

Causes by Organ System

Causes in Alphabetical Order

• Aortic valve regurgitation Mixed with aortic stenosis

Related chapters

References

Pulsus Bisferiens Usmle

Pulsus Bisferiens Waveform