1. Bisferiens Pulse Pronounce

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]

Pulsus bigeminus is a cardiovascular phenomenon characterized by groups of two heartbeats close together followed by a longer pause. The second pulse is weaker than the first. Look for a pattern of what appears to be a relatively normal QRS complexes, each followed by a smaller, abnormal one.The smaller beat is palpated as either a missing or an extra beat, and on EKG resembles a PVC. Same pulse is figured by Sir W. Broadbent in his description of the pulsus bisferiens.5 Sir W. Broadbent associates this pulse with aortic stenosis, and attributes its second beat to quota re- inforcement of a prolonged systole near its close. quot It is easy to see that such a pulse may easily be trans- formed into an anacrotic one; some of the beats in Fig. 5 and those in the upper of the two tracings given by Sir W.

Dragon dictate mac user manualyellowplane. 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]

Pulsus bigeminus is a cardiovascular phenomenon characterized by groups of two heartbeats close together followed by a longer pause. The second pulse is weaker than the first. Look for a pattern of what appears to be a relatively normal QRS complexes, each followed by a smaller, abnormal one. The smaller beat is palpated as either a missing or an extra beat, and on EKG resembles a PVC.^[1] These PVCs appearing every other beat are also called extrasystoles.

This phenomenon can be a sign of hypertrophic obstructive cardiomyopathy or of many other types of heart disease (see list below). Other causes include digitalis toxicity, induction of anesthesia,^[2] placement of surgical instrumentation into the thorax or as a benign, temporary phenomenon.

In Pulsus Bigeminus not all of the conducted electrical activity will elicit sufficient ventricular contraction to produce a palpable pulse. This is important for two reasons. One, an ECG may give a ventricular contraction rate that does not correspond to the palpated pulse rate. Secondly, because not all beats are being conducted, patients may present with symptoms of low output heart failure, e.g. Dizziness, shortness of breath or hypotension, even with a normal ECG.

Cause[edit]

Causes Include:

1. Electrolyte imbalance e.g. Hypo or hyperkalemia
2. Betablocker therapy
3. Destruction or degeneration of the cardiac conduction system or heart muscle cells
4. Infection

A doctor can discriminate pulsus bigeminus from pulsus alternans by auscultating the heart.

Management[edit]

Management includes looking for and removing underlying cause, including medicines (such as a Calcium Channel blocker) and inotropic therapy to return cardiac output back to normal. If highly symptomatic over a longer period ablation therapy may be the only viable option.

See also[edit]

References[edit]

1. ^Anand, Nidhi; Manish Anand; Alok Vardhan Mathur; Madhukar Maletha; SK Ghildyal (2010-02-03). 'Intra-operative ventricular bigeminy: Can retractor be a cause'. Journal of Anaesthesiology Clinical Pharmacology. 26 (4): 569–570. Retrieved 2012-05-16.
2. ^ROLLASON, WN; D. J. HALL (March 1973). 'Dysrhythmias during inhalational anaesthesia for oral surgery'. Anaesthesia. 28 (2): 139–145. doi:10.1111/j.1365-2044.1973.tb00305.x.

Bisferiens Pulse Pronounce