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is pulses bisferiens the same as water-hammer pulse?

asked in medicine, cardiology

cryptminder answers:

Pronunciation: ( bis-fer¢e-us puls) Having two beats; an arterial pulse with peaks that may be palpable. syn: pulsus bisferiens
According to Wiki:-
In medicine, pulsus bisferiens, also bisferious pulse or biphasic pulse, is a sign where, on palpation of the pulse, a double peak per cardiac cycle can be appreciated. Bisferious means striking twice. Classically, it is detected when aortic insufficiency exists in association with aortic stenosis, but may also be found in isolated but severe aortic insufficiency, and hypertrophic obstructive cardiomyopathy.

From http://cmbi.bjmu.edu.cn/uptodate/cardiac%20evaluation/Examination%20of%20the%20a...

PULSUS BISFERIENS — The normal carotid arterial pulse tracing and the central aortic pulse waveform consist of an early, the percussion wave, that results from rapid left ventricular ejection, and a second smaller peak, the tidal wave, presumed to represent a reflected wave from the periphery. The tidal wave may increase in amplitude in hypertensive patients or in those with elevated systemic vascular resistance. Radial and femoral pulse tracings demonstrate a single sharp peak in normal circumstances.

Pulsus bisferiens is characterized by two systolic peaks of the aortic pulse during left ventricular ejection separated by a midsystolic dip. Both percussion and tidal waves are accentuated. It is difficult to establish with certainty that the two peaks are occurring in systole with simple palpation (pulsus bisferiens) versus one peak in systole and the other in diastole (dicrotic pulse).

Etiology — Pulsus bisferiens is frequently observed in patients with hemodynamically significant (but not mild) aortic regurgitation. In patients with mixed aortic stenosis and aortic regurgitation, bisferiens pulse occurs when regurgitation is the predominant lesion. The absence of pulsus bisferiens does not exclude significant aortic regurgitation.

In most patients with hypertrophic cardiomyopathy the carotid pulse upstroke is sharp and the amplitude is normal; pulsus bisferiens is rarely palpable but often recorded. The rapid upstroke and prominent percussion wave result from rapid left ventricular ejection into the aorta during early systole. This is followed by a rapid decline as left ventricular outflow tract obstruction ensues, a result of midsystolic obstruction and partial closure of the aortic valve. The second peak is related to the tidal wave. Occasionally, a bisferiens pulse is not present in the basal state but can be precipitated by Valsalva maneuver or by inhalation of amyl nitrite.

Pulsus bisferiens is occasionally felt in patients with a large patent ductus arteriosus or arteriovenous fistula. A bisferiens quality of the arterial pulse also is rarely noted in patients with significant mitral valve prolapse and, very rarely in normal individuals, particularly when there is a hyperdynamic circulatory state.

Mechanism — The mechanism of pulsus bisferiens is not clear. It appears to be related to a large, rapidly ejected left ventricular stroke volume associated with increased left ventricular and aortic dp/dt.

Normally arterial pulses are best felt in central arteries like brachial and carotid, but pulsus bisferiens is an exception to that and can be better felt in peripheral arteries like the radial artery. Another such pulse which can be felt better in peripheral arteries is pulsus alterans. The first lift is due to "percussion wave"(P) and the second lift is due to tidal wave (T).

So no they are not the same

Supplement from 07/24/2008 08:36am:

Sorry this description of the water pulse was omitted

Font SizeA A A Definition of Pulse, water hammer

Pulse, water hammer: A jerky pulse that is full and then collapses because of aortic insufficiency (when blood ejected into the aorta regurgitates back through the aortic valve into the left ventricle). This type of pulse was likened to a water hammer, a Victorian toy consisting of a glass tube filled partly with water or mercury in a vacuum. The water or mercury produced a slapping impact when the glass tube was turned over. Also called a Corrigan pulse or a cannonball, collapsing, pistol-shot, or trip-hammer pulse.

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