STUDY - Technical - New Dacian's Medicine
Pulsus
bisferiens (Classical / Allopathic Medicine)S
A
bisferiens pulse is a hyperdynamic, double-beating pulse
characterized by two systolic peaks separated by a
midsystolic dip. Both peaks may be equal or either may be
larger; however, the first peak is typically taller or
more forceful than the second. The first peak (percussion
wave) is believed to be the pulse pressure; the second
(tidal wave), is reverberation from the periphery. Pulsus
bisferiens occur in conditions such as aortic
insufficiency (the most common organic cause of pulsus
bisferiens), in which a large volume of blood is rapidly
ejected from the left ventricle. The pulse can be palpated
in peripheral arteries or observed on an arterial pressure
wave recording.
To
detect pulsus bisferiens, lightly palpate the carotid,
brachial, radial, or femoral artery. (The pulse is easiest
to palpate at the carotid artery.) At the same time,
listen to the patient's heart sounds to determine whether
the two palpable peaks occur during systole. If they do,
you'll feel the double pulse between the first and second
heart sounds.
HISTORY:
Review the patient's medical history for cardiac disorders or other illnesses.
Ask the patient about associated signs and symptoms, such as dyspnea, chest pain, or fatigue. If the patient has experienced associated signs and symptoms, ask how long he has had these symptoms and whether they change with activity or rest.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs.
Review the patient's medical history for cardiac disorders or other illnesses.
Ask the patient about associated signs and symptoms, such as dyspnea, chest pain, or fatigue. If the patient has experienced associated signs and symptoms, ask how long he has had these symptoms and whether they change with activity or rest.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Auscultate for abnormal heart or lung sounds.
Take the patient's vital signs.
Auscultate for abnormal heart or lung sounds.
SPECIAL
CONSIDERATIONS:
When obtaining the patient's pulse at the carotid artery, use caution; pressure on the carotid artery can cause the patient's heart rate to decrease.
When obtaining the patient's pulse at the carotid artery, use caution; pressure on the carotid artery can cause the patient's heart rate to decrease.
PEDIATRIC
POINTERS:
Pulsus bisferiens may be palpated in children with a large patent ductus arteriosus and in those with congenital aortic stenosis and insufficiency.
Pulsus bisferiens may be palpated in children with a large patent ductus arteriosus and in those with congenital aortic stenosis and insufficiency.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include an electrocardiogram, chest X-ray, cardiac catheterization, and angiography.
Instruct the patient on what to expect from diagnostic testing, which may include an electrocardiogram, chest X-ray, cardiac catheterization, and angiography.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.