Abnormalities of Heart

• Pulsus bisferiens

  
  

  Characteristics:

  • Double systolic peak

  Causes:

  • Pure aortic regurgitation
  • Combined aortic stenosis and regurgitation
  • Hypertrophic cardiomyopathy
• Pulsus alternans

  
  

  Characteristics:

  • Regular rhythm
  • Changes in amplitude (or strength) from beat to beat

  Cause:

  • Left ventricular failure (usually accompanied by an S3 sound on the left)
• Bigeminal Pulse

  
  

  Characteristics:

  • Regular, irregular rhythm (one normal beat followed by a premature contraction)
  • Alternates in amplitude (one strong pulse followed by a quick, weaker one)

  Cause:

  • Premature ventricular contraction
• Paradoxical pulse

  
  

  Characteristics:

  • Palpable decrease in pulse amplitude on quiet aspiration
  • Pulse becomes stronger with expiration

  Causes:

  • Pericardial tamponade
  • Constrictive pericarditis
  • Obstructive lung disease
• Premature atrial or junctional contractions - these beats occur earlier than the next expected beat and are followed by a pause. The rhythm resumes with the next beat
• Sinus arrhythmia - HR speeds up and slows down in a cycle usually becoming faster with inhalation and slower with expiration
• Atrial Fibrillation and Atrial Flutter with varying ventricular response - ventricular contraction occurs irregularly. At times, short runs of the irregular rhythm may appear regularly.
• Premature ventricular contractions occur at the next expected beat and are followed by a pulse. The rhythm resumes with the next beat