What does Pulsus alternans indicate?

Pulsus alternans indicate cardiac pathology, particularly left ventricular dysfunction and is considered a poor prognostic indicator. When identified, pulsus alternans should elicit prompt treatment of the underlying causative process.

What is Hypokinetic pulse?

If the pulse is present but of low volume and amplitude, it is hypokinetic. This could suggest low cardiac output in shock or myocardial infarction. Idiopathic dilated cardiomyopathy, valvular stenosis, pericardial tamponade, or constrictive pericarditis can also cause low cardiac output and small peripheral pulses.

Does blood pressure increase with inspiration?

Systemic blood pressure is not constant but varies slightly from heart beat to heart beat and between inspiration and expiration. Normally, the systolic blood pressure decreases by less than 10 mmHg during inspiration, but a decline of this magnitude is not detectable on examination of the peripheral pulse.

How do you demonstrate Pulsus alternans?

Next use a blood pressure cuff to confirm the finding: Inflate the blood pressure cuff past systolic pressure and then slowly lower cuff pressure towards the systolic level. If alternating loud & soft Korotkoff sounds are heard, pulsus alternans is indicated.

How do you assess Pulsus alternans?

To measure the pulsus paradoxus, patients are often placed in a semirecumbent position; respirations should be normal. The blood pressure cuff is inflated to at least 20 mm Hg above the systolic pressure and slowly deflated until the first Korotkoff sounds are heard only during expiration.

What is the pathophysiology of pulsus paradoxus?

Pulsus paradoxus results from alterations in the mechanical forces imposed on the chambers of the heart and pulmonary vasculature and is often due to pericardial disease, particularly cardiac tamponade and to a lesser degree constrictive pericarditis.

What is Pulsus Filiformis?

a small fine pulse, feeling like a small cord or thread under the finger. Synonym(s): pulsus filiformis.

What causes arterial pulse?

pulse, rhythmic dilation of an artery generated by the opening and closing of the aortic valve in the heart. A pulse can be felt by applying firm fingertip pressure to the skin at sites where the arteries travel near the skin’s surface; it is more evident when surrounding muscles are relaxed.

Why does BP fall during inspiration?

During inspiration, systolic blood pressure decreases, and pulse rate goes up. This is because the intrathoracic pressure becomes more negative relative to atmospheric pressure. This increases systemic venous return, so more blood flows into the right side of the heart.

How do you assess for pulsus paradoxus?

To measure pulsus paradoxus all you need is a stethoscope and a blood pressure cuff. To test for pulsus paradoxus slowly look for the first quarter cough sound. That will appear then disappear during inspiration. Next slowly listen for when the first quarter cough sound no longer disappears with inspiration.

What is pulsus bisferiens?

Pulsus bisferiens. Pulsus bisferiens occurs in patients with significant aortic valve regurgitation. A double pulse is felt due to the backflow of blood in early diastole. The first carotid pulse felt is normal systole, while the second is actually early diastolic due to the regurgitating blood.

What causes pulsus bisferiens in hypertrophic cardiomyopathy?

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.

How is pulsus bisferiens detected in aortic regurgitation?

Most frequently caused by hemodynamically significant aortic regurgitation, pulsus bisferiens is detected by examining the carotid upstroke. Two pulsations are detected in systole.

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