Image Based Question-68052

Which among the following are the causes of the pulse type shown in the picture below ?

A. Left ventricular failure.

B. Toxic myocarditis.

C. Paroxysmal Tachycardia.

D. All of the above.

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Correct Answer » D Explanation

Ans:D. All of the above.

The pulse type shown in the picture above represents Pulsus Alternans.

Patterns of Pulse.

Anacrotic Pulse

• Anacrotic pulse is a slow rising, twice beating pulse where both the waves are felt during systole. The waves that are felt are the anacrotic wave and the tidal wave. It is best felt in the carotids in aortic stenosis.

Pulsus Bisferiens

• Pulsus bisferiens is a rapid rising, twice beating pulse where both the waves are felt during systole. Here the percussion wave is felt first followed by a small wave. It is seen in:

• Idiopathic hypertrophic subaortic stenosis

• Severe A.I. with mild A.S.

Pulsus Parvus ET Tardus

• Pulsus Parvus ET Tardus is a slow rising pulse like the anacrotic pulse but the anacrotic wave is not felt. It is seen in aortic stenosis.

Pulsus Alternans

• Pulsus alternans is characterized by a strong and weak beat occurring alternately, probably due to alternate rather than regular contraction of the muscle fibres of the left ventricle.

• Causes are left ventricular failure, toxic myocarditis, paroxysmal tachycardias.

Pulsus Paradoxus

• A condition in which some heartbeats cannot be detected at the radial artery during the inspiration phase of respiration. It is caused by an exaggerated decrease in blood pressure during this phase

• Pulsus paradoxus is seen in superior vena cava obstruction, lung conditions like asthma, emphysema or airway obstruction, cardiac conditions like pericardial effusion, constrictive pericarditis and severe congestive cardiac failure.

Pulsus Bigeminus

• Pulsus bigeminus is coupling of the pulse waves in pair, followed by a pause. It is seen in alternate premature beats, A.V. block, and sinoatrial block with ventricular escape

Thready Pulse

• The pulse rate is rapid and the pulse wave is small and disappears quickly. This is seen in shock especially cardiogenic.

Waterhammer Pulse

• A pulse that is bounding and forceful,rapidly increasing and subsequently collapsing,as if it were the sound of a waterhammer that was causing the pulse.

• Seen in Aortic regurgitation