Pulsus bisferiens

Pulsus bisferiens, also known as biphasic pulse, is an aortic waveform with two peaks per cardiac cycle, a small one followed by a strong and broad one.[1] It is a sign of problems with the aorta, including aortic stenosis and aortic regurgitation, as well as hypertrophic cardiomyopathy causing subaortic stenosis.[1]

Pulsus bisferiens
Other namesBisferious pulse, biphasic pulse
SpecialtyCardiology

Pathogenesis

In hypertrophic cardiomyopathy, there is narrowing of the left ventricular outflow tract (LVOT) due to hypertrophy of the interventricular septum. During systole, the narrowing of the LVOT creates a more negative pressure due to the Venturi effect and sucks in the anterior mitral valve leaflet. This creates a transient occlusion of the LVOT, causing a midsystolic dip in the aortic waveform. Towards the end of systole, the ventricle is able to overcome the obstruction to cause the second rise in the aortic waveform.[2]

In severe aortic regurgitation, additional blood reenters the left ventricle during diastole. This added volume of blood must be pumped out during ventricular systole. The rapid flow of blood during systole is thought to draw the walls of the aorta together due to the Venturi effect, temporarily decreasing blood flow during midsystole.[2]

A recent paper theorized that an alternative explanation for pulsus bisferiens may be due to a forward moving suction wave occurring during mid-systole.[3]

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References
  1. Riojas CM, Dodge A, Gallo DR, White PW (January 2016). "Aortic Dissection as a Cause of Pulsus Bisferiens: A Case Report and Review". Annals of Vascular Surgery. 30: 305.e1–5. doi:10.1016/j.avsg.2015.07.026. PMID 26520426.
  2. McGee SR (2018). "Chapter 15: Pulse Rate and Contour". Evidence-based physical diagnosis (Fourth ed.). Philadelphia, PA: Elsevier. pp. 95–108. ISBN 978-0-323-50871-1. OCLC 959371826.
  3. Chirinos JA, Akers SR, Vierendeels JA, Segers P (March 2018). "A Unified Mechanism for the Water Hammer Pulse and Pulsus Bisferiens in Severe Aortic Regurgitation: Insights from Wave Intensity Analysis". Artery Research. 21: 9–12. doi:10.1016/j.artres.2017.12.002. PMC 5863934. PMID 29576810.
Classification
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